A new Cochrane Review concludes that all countries should consider establishing proper home birth services. They should also provide low-risk pregnant women with information enabling them to make an informed choice. The review has been prepared by senior researcher, statistician Ole Olsen, the Research Unit for General Practice, University of Copenhagen, and midwifery lecturer PhD Jette Aaroe Clausen.
In many countries it is believed that the safest option for all women is to give birth in hospital. However, observational studies of increasingly better quality and in different settings suggest that planned home birth in many places can be as safe as planned hospital birth and with less intervention and fewer complications.
“If home birth is going be an attractive and safe option for most pregnant women, it has to be an integrated part of the health care system,” Ole Olsen says and adds, “In several Danish regions the home birth service has been very well organised for several years. This is not the case everywhere in the world.”
The updated Cochrane Review concludes that there is no strong evidence from experimental studies (randomised trials) to favour either planned hospital birth or planned home birth for low-risk pregnant women. At least not as long as the planned home birth is assisted by an experienced midwife with collaborative medical back up in case transfer should be necessary.
Fewer interventions in home birth
Routines and easy access to medical interventions may increase the risk of unnecessary interventions in birth explaining why women who give birth at home have a higher likelihood for a spontaneous labour. There are 20-60 per cent fewer interventions, for example fewer cesarean sections, epidurals and augmentation among those women who plan a homebirth; and 10-30 per cent fewer complications, for example post partum bleeding and severe perineal tears.
“Patience is important if women want to avoid interference and give birth spontaneously,” says Jette Aaroe Clausen. “At home the temptation to make unnecessary interventions is reduced. The woman avoids for example routine electronic monitoring that may easily lead to further interventions in birth.”
Jette Aaroe Clausen adds that interventions in childbirth are common in many countries, but also that there is a growing concern internationally because interventions may lead to iatrogenic effects; iatrogenic effects meaning unintended consequences of the intervention. Routine electronic monitoring may for example lead to more women having artificial rupture of membranes which in turn can lead to more interventions.
Evidence and human rights
While the scientific evidence from observational studies has been growing, the European Court of Human Rights in Strasbourg in the case Ternovszky versus Hungary has handed down a judgment stating that “the right to respect for private life includes the right to choose the circumstances of birth”. This is quoted in the review.
Thus the conclusions of the review are based on human rights and ethics as well as on results from the best available scientific studies.
Further information
Ref.: Olsen O, Clausen JA. Planned hospital birth versus planned home birth. The Cochrane Library, Issue 9, 2012.
The full review may be available here (depends on country): http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD000352.pub2/abstract
The full review is also available as PDF: Planned hospital birth versus planned home birth.
To those who believe home birth to be a perfectly legitimate and healthy course in pregnancy, no further information is necessary. To those who do not, no further information will suffice.
Let’s stop pretending this is about “science”.
‘ birth no reason to go to hospital’ , In my place, ukhrul district , India there is no hospital almost all childs were born at home with the help of widwives safely. but most of the women have womb related problems including bleeding, aching , cancer and many women never regain normal health.
Those whom actually read the entire review will be able to understand that the trial with 11 women that did not have enough data was only a very small portion included with the entire study, and therefore conscientiously stated as being a weakness as is done with any good statistical analysis, in which two of the studies reviewed did meet the stricter inclusion data (upon which the main conclusions were drawn).
The AMA-petting dogmatic anti-midwife ranters are certainly NOT correct and the same AMA-supported writer(s) once again making blanket defamatory judgments based upon statements taken out of context are nothing more than embarrassing the medical profession.
Consider that in the U.S. homebirth mortality “outcomes” include those several weeks after being transferred to a hospital, where they include in the homebirth midwife mortality statistics those due to in-hospital teratogenic or iatrogenic error or patient reactions, or anomalies incompatible with life, or unassisted homebirth transfers, etc. So although by scientific standards the “midwifery” statistics are not considered significantly different from hospital statistics, the outcomes for actual skilled midwife-assisted homebirths are likely even better than that.
The results as described in the review are quite accurate.
The results may be accurate: not enough data, but the conclusions are not supported by the results.
After 10 pages of descriptions of statistical methods, midwifery dogma, and pas attempts at meta-analysis, the truth comes out: only 1 of 6 studies meets the inclusion criteria and it is underpowered (11 women).
I come from a different area of science and this is just ridiculous. It is poorly disguised midwife advocacy masquerading as science.
Giving birth is a natural phenomenon. If enough care is taken for cleanliness home birth is better unless any complication is fore seen.
The review concludes nothing of the kind. Here’s what the review actually says:
“Two trials met the inclusion criteria but only one trial involving 11 women provided some outcome data and was included. The evidence from this trial was of moderate quality and too small to allow conclusions to be drawn.”
In other words, they didn’t analyze any data and could therefore draw NO conclusions.
“The review has been prepared by senior researcher, statistician Ole Olsen, the Research Unit for General Practice, University of Copenhagen, and midwifery lecturer PhD Jette Aaroe Clausen.”
they must give PhDs for anything in Copenhagen if this is the quality of their research! What a terrible “study”. What a BS journal. What a biased researcher! Call her what she is: a dogmatic midwifery advocate who doesn’t think she needs actual evidence to support her claims.