Women giving birth at home or in birth centres are more likely to have a normal vaginal birth, with no difference in adverse infant outcomes compared with hospital births,
a meta-analysis shows.
The choice of homebirth means women with low-risk pregnancies are nearly three times more likely to have a non-instrumental delivery than if they have a planned hospital birth, the Australian researchers say.
The NHMRC-funded meta-analysis and systematic review also shows babies born at home are 30% less likely to be admitted to neonatal intensive care.
The review included 28 studies from high-income countries, including five from Australia, that compared outcomes based on place of delivery.
While absolute numbers for adverse events such as stillbirth and early infant death were small, the odds of either occurring were no different between birth locations.
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The findings call into question advice from RANZCOG that hospital is the safest place to give birth, according to the study’s co-author, obstetrician Professor David Ellwood, from Griffith University on
the Gold Coast.
“There’s increasing evidence that for low-risk women not in their first pregnancy, there’s no difference in outcomes at all,” says Professor Elwood.
RANZCOG’s position statement on homebirths, updated last year, says that even for a pregnancy without complicating factors, the risk of planned homebirth “is at a level that is unacceptable to most women”.
The statement adds that a small group of women are prepared to accept the risks associated with homebirth and that these women should be “maximally supported” although that support cannot completely mitigate these risks.
But Professor Ellwood said: “What our study is showing is for low-risk women, it’s hard to justify the statement that the risks are unacceptably high.”
The meta-analysis showed that across nine perinatal and maternal outcomes, the odds either favoured homebirth or birth centres or there was no difference between these birth locations and a hospital
obstetrics unit.
The findings supported the expansion of birth centres and homebirth services for women with low-risk pregnancies and should help women make more informed choices about where to give birth, the study authors wrote.
