Monday, August 31, 2009
Study: Home Births Can Be As Safe As Hospital Ones
Obstetricians around the world are split on their support of births outside a hospital setting. OB groups in Australia and New Zealand are opposed to home births, and the American College of Obstetricians and Gynecologists is unequivocal.
The group said complications can arise "with little or no warning even among women with low-risk pregnancies" and that childbirth shouldn't be influenced "by what's fashionable, trendy or the latest cause celebre."
In contrast, the Royal College of Obstetricians and Gynaecologists in the United Kingdom supports home births as a viable choice for women with uncomplicated pregnancies.
The study comes just weeks after the leaders of Canada's pregnancy specialists are urging doctors to "normalize" childbirth and lower the rates of C-sections and other interventions.
"We definitely understand that it's a woman's decision to choose where she wants to give birth, in a hospital or a home," said Dr. Andre Lalonde, executive vice-president of the Society of Obstetricians and Gynaecologists of Canada. "We don't have anything against (home births) for selected, low-risk women."This is the second study the B.C. group has reported on the safety of home births. In 2002, the team reported on a smaller study involving 862 planned home births.
"This one allows us to say definitively what the rates of perinatal death are," said lead author Patricia Janssen, an associate professor in the School of Population and Public Health at the University of B.C. "Our first study was really too small to look at that with confidence."
The new study involved 2,889 women attended by a midwife who began labour with the intention of giving birth at home. They were compared to 4,752 planned hospital births attended by the same group of midwives, and 5,331 physician-attended hospital births.
In order to qualify for the study, all the women met the same eligibility requirements for a home birth, meaning they were equally low-risk women.
The criteria included:
The rates of perinatal deaths — defined as stillbirths after 20 weeks' gestation, or death in the baby's first seven days of life — was low in all three groups:
"In every other measure that we looked at that measures morbidity, there was no difference," Janssen said. "When we looked at Apgar scores (a test to determine the physical condition of a newborn infant), and asphyxia, and trauma at birth and the need for resuscitation and oxygen therapy — all of those things were not different, or in some cases they were lower in the home-birth group."They also cautioned that the findings may not be applicable across the country. Midwifery is regulated on a province-by-province basis. The findings "do not extend to settings where midwives do not have extensive academic and clinical training." The following comes from a list of suggested client supplies for home births, from the College of Midwives of British Columbia's Home Birth Handbook for Midwifery Clients: