FOR LOW RISK, HEALTHY PREGNANT WOMEN, HOMEBIRTH IS JUST AS SAFE AS HOSPITAL BIRTH FOR BOTH MOTHER AND BABY 

There is an abundance of literature now available proving time and time again that for low risk, healthy pregnancy women, home birth is just as safe, if not SAFER, than hospital birth.  Check our Homebirth News page for the latest reports.

The most recent research contained in the Cochrane systematic review of the literature,  (published on the Cochrane database; the source from which our hospital policies are usually created),  still states that there is not enough evidence to decide one way or another, whether home or hospital birth is safer (Olsen & Jewell: 2000 (CD000352) in Hofmeyr et al:2008:252). In fact, Hofmeyr goes on to say, on behalf of the Cochrane database; "The relative benefits and risks of different settings are difficult to quantify. For a woman and her baby with no complications, the risk of an unexpected adverse event during a home birth may be smaller than risks specific to hospitalisation, such as hospital-aquired infections" (Hofmeyr et al:2008). Olsen and Jewell (2000), the authors of the systematic review also state: "In countries where it is possible to establish a home birth service backed up by a modern hospital system, all low-risk women should be offered the possiblity of considering a planned home birth...." (Olsen & Jewell: 2000 (CD000352) in Buckley:2005:230).

Today, publicly funded home birth programs exist in almost every state in Australia, and in other countries such as New Zealand, Netherlands and the United Kingdom, with statistics continuing to show outcomes that are at least as good as hospital births for both mothers and their babies.

The latest study from The Netherlands was published in BJOG in April 2009. This study looked at "perinatal mortality and morbidity in a nationwide cohort of 529,688 low-risk planned home and hospital births" (de Jonge et.al:2009). Results of this study showed "that planning a homebirth does not increase the risks of perinatal mortality and severe perinatal morbidity among low-risk women, provided the maternity care system facilitates this choice through the availability of well-trained midwives and through a good transportation and referral system" (de Jonge et. al:2009). In terms of safety, no significant differences were found in either planned home births or planned hospital births during the seven years that the study was conducted (de Jonge et.al:2009). 

_References:

_{Buckley, S: 2005: Gentle Birth, Gentle Mothering; One Moon Press, Brisbane.}

_{de Jonge et. al.:2009: "Perinatal mortality and morbidity in a nationwide cohort of 529,688 low-risk planned home and hospital births": BJOG 2009: DOI: 10.1111/j.1471-0528.2009.02175.x}

_{Hofmeyr et. al.: 2008: A Cochrane Pocketbook; Pregnancy and Birth: John Wiley & Sons Ltd, West Sussex.}

Research papers and websites detailing the safety of homebirth:

The following list of research papers have been compiled by Angela Horn and is available from: http://www.homebirth.org.uk/  

"How do we know which studies are fair? The notes on methodology offer some pointers. Some critics of homebirth safety feel that much of the research on homebirth is biased in its favour, and so I intend during 2007 to give more detailed critiques of the studies listed here. I do not believe that homebirth advocates need to rely on substandard research; it is important that women can feel confident in the studies they use to inform their choices."

1. National Birthday Trust Report By Chamberlain et al, 1997 - enquiry into UK home births in 1994.
2. Birth at home By Chamberlain, Wraight and Crowley, 1997.
3. British Medical Journal editorial on home births, 23 November 1996
4. Outcome of planned home and planned hospital births in low risk pregnancies: prospective study in midwifery practices in the Netherlands By Wiegers, Keirse, van der Zee and Berghs, 1996
5. Prospective regional study of planned home births By Davies et al, 1996 (Interesting data on transfers to hospital)
6. Home versus hospital deliveries: follow up study of matched pairs By Ackermann-Liebrich et al, 1996
7. Collaborative survey of perinatal loss in planned and unplanned home births Northern Region Perinatal Mortality Survey Coordinating Group, 1996
8. Perinatal deaths associated with planned home birth in Australia By Bastian et al, 1998
9. Home births in South-West Australia By Howe, 1988
10. A matched cohort study of planned home and hospital births in Western Australia 1981-1987 By Woodcock et al.
11. Home Birth in New Zealand, 1973-1993 By Gulbransen et al.
12. Place of delivery: a review, by Campbell et al, 1986
13. Home births in England and Wales, 1979, by Campbell et al, 1984
14. The Safety of Home Birth: The Farm Study by A. Mark Durand, MD, MPH, 1992
15. Five year prospective study of risk of booking for a home birth in Essex by JM Shearer, 1985
16. Licensed midwife-attended, out-of-hospital births in Washington State: are they safe? By Janssen et al, 1994
17. Outcomes of 1001 midwife-attended home births in Toronto, 1983-1988 by H Tyson, 1991
18. Outcomes of planned home births in an inner-city practice By Ford et al, 1991
19. Birth setting for low-risk pregnancies By Albers and Katz, 1991
20. Outcomes of intended home births in nurse-midwifery practice By Murphy and Fullerton, 1998
21. Meta-analysis of the safety of home birth By Olsen, 1997
22. Outcomes of 11,788 planned home births attended by certified nurse-midwives. A retrospective descriptive study By Anderson and Murphy, 1995.
23. Data on babies' safety during hospital births are being ignored - Drife, 1999.
24. Do obstetric intranatal interventions make birth safer? - Tew, 1986
25. Are hospital confinements really more dangerous for the fetus? - Golding and Peters, 1988
26. Home versus hospital birth - Cochrane Database Review - Olsen and Jewell, 2000
27. Simulated home delivery in hospital - a randomised, controlled trial By MacVicar et al., 1993
28. The Cost-Effectiveness of Home Birth By Anderson and Anderson, 1999
29. Physician- and midwife-attended home births: effect of breech, twin and post-dates outcome on mortality rates. By Mehl-Madrona and Madrona, 1997
30. Home Delivery and Scientific Reasoning By Olsen, 1994
31. Perineal outcomes in a home birth setting By Aikins Murphy and Feinlan, 1998
32. Blues and depression during early puerperium: home versus hospital deliveries By Pop et al, 1995.
33. Home birth and hospital deliveries: a comparison of the perceived painfulness of parturition By Morse and Park, 1988.
34. Babies born before arrival at hospital, by Bhoopalam and Watkinson, 1991
35. Transfer from home to hospital: what is its effect on the experience of childbirth? By Wiegers et al, 1998.
36. Place of delivery in The Netherlands: actual location of confinement By Kleiverda et al, 1991.
37. Four years' experience with home birth by licensed midwives in Arizona. By Sullivan and Beeman, 1983

(Source: Angela Horn, http://www.homebirth.org.uk/ )