Home birth as safe as in hospital for low risk women, study shows

BMJ 2009; 338 doi: (Published 20 April 2009) Cite this as: BMJ 2009;338:b1616
  1. Helen MacDonald
  1. 1BMJ

    Home birth is as safe as hospital birth for women at low risk, according to the results of a Dutch cohort study of 529 688 women. But the authors say that a prospective study is needed (British Journal of Obstetrics and Gynaecology 2009;116:1-8).

    “In our research, we studied more than half a million women in primary care and compared planned home births with planned hospital births,” said the lead researcher Simone Buitendijk, head of the child health programme at the Netherlands Organisation for Applied Scientific Research.

    All low risk women, who gave birth between January 2000 and December 2006, were included. Just over 60% planned to give birth at home, 30.8% in hospital, and the rest did not specify. The researchers compared the risk of intrapartum death, neonatal death, and admission to neonatal intensive care, according to the women’s delivery plans.

    “The number of babies that died or were admitted to a neonatal intensive care unit was the same in both groups, namely, seven per 1000,” the researchers found. Poor outcomes were more likely in women who were primiparous, who delivered outside 38-40 weeks’ gestation, were under 25 or older than 35, or were not Dutch.

    Controversy surrounds the safety of home birth in the Netherlands. Previous cohort studies have produced conflicting results, and the strength of their findings has been limited by small sample sizes because adverse outcomes are rare. Professor Buitendijk’s is the largest study of its kind and has capitalised on the high rates of home birth in the Netherlands—about 30% compared with 2.7% in the United Kingdom in 2006.

    “We conclude that women can safely choose where they want to give birth, provided the maternity care system is well equipped for home births,” said Professor Buitendijk.

    Expanding on that caveat, Philip Steer, obstetrician and gynaecologist, and editor in chief of the BJOG, said, “It must be noted that maternity services in the Netherlands are set up to meet the demand for home births, transport is good, and distances short if emergency transfer to hospital is needed. The same advantages are not available in all places in the UK, so the safety of home birth has to be considered in the context of the availability of local services.

    “We look forward to the Birthplace in England study, presently being conducted by the National Perinatal Epidemiology Unit, as their data will give us a reasonably accurate picture of the relative safety of home births in the UK for the first time.”

    As well as the transferability of the finding, Professor Steer explained a limitation of the study design: “Evaluating the safety of home births is difficult because very few studies randomise the place of birth, and thus even after excluding obvious risk factors, women who choose birth at home may differ systematically from women who choose hospital birth.”

    “Nonetheless, this large retrospective cohort study is reassuring about the relative safety of planning home births if women are low risk.”

    Mary Newburn, head of research and information at the National Childbirth Trust, agreed that the study “makes a significant contribution to the growing body of reassuring evidence that suggests offering women a choice of place of birth is entirely appropriate.”

    Professor Buitendijk’s research team emphasised the need for prospective study designs. A randomised control trial would produce the best evidence, but research has shown that women are not prepared to participate in a randomised controlled trial of place of birth.


    Cite this as: BMJ 2009;338:b1616

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