In Out-of-Hospital Birth

The Toronto Star reports on a large study comparing outcomes between 11,493 low-risk Canadian women planning home birth at the onset of labor and a random sample of 11,493 equally low-risk women planning hospital birth, both cared for by the same midwives. To eliminate confounding by risk imbalances between the two groups, the populations were matched to produce identical percentages having a 1st baby and percentages with a prior cesarean. (Prior cesarean didn’t exclude women from home birth.)

No differences were found in the health of the babies according to a composite measure of morbidity or mortality (any of the following: Apgar < 4 at 5 minutes, infant resuscitation requiring positive pressure ventilation and cardiac compressions, death after labor onset, or death within 28 days of birth). No differences were found in any of the individual elements of the composite outcome either. Nor were differences found when comparing the composite outcome or its elements in women having a 1st baby or in women with prior births.

On the other hand, women planning hospital birth were more likely to experience medical interventions and morbidity. They were more likely to have labor augmented either by rupturing membranes or administering IV oxytocin, to have pain relief medication, to have an episiotomy, and to have an instrumental vaginal or cesarean delivery. They were also more likely to have a tear into or through the anal sphincter and to have severe postpartum bleeding. These differences were also found when 1st-time mothers and women with prior births were compared. Study authors theorize that the excess use of medical intervention probably has to do with a combination of differing preferences on the part of women choosing home birth and differences in care in the two environments.

Unlike the American Congress of Obstetricians and Gynecologists (and similar to the U.K. Royal College of Obstetricians and Gynaecologists), the Society of Obstetricians and Gynecology of Canada (SOGC) supports home birth in screened women attended by qualified home birth providers. The Star quotes Dr. Jennifer Blake, CEO of the SOGC:

“It is reassuring for those women who are found to be suitable candidates for planned birth, that this study is consistent with other research showing that it is a safe option. However, careful assessment is always essential to select the right women for out-of-hospital delivery. The SOGC supports collaborative maternity care and the important role that midwives play in caring for healthy women with uncomplicated pregnancies.”

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