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I came across the following page, describing "The Farm"'s midwifery statistics: http://www.naturalbirthandbabycare.com/farm-statistics.html

That page wasn't that convincing. The only statistic that it directly compared against conventional birthing is the rate at which caesarian section is performed. That fewer c-sections are done is marvellous, but it doesn't prove that it's safe.

However, I clicked on a link from that page to http://www.naturalbirthandbabycare.com/home-birth.html , which talks about a paper published in BMJ: Outcomes of planned home births with certified professional midwives: large prospective study in North America. That paper doesn't seem to be looking at maternal mortality, but says that other research has already shown that home birthing for low risk mothers has similar safety to low risk hospital mothers.

http://www.naturalbirthandbabycare.com/home-birth.html also claims that studies showing home birthing for low risk mothers has a higher risk include counting unplanned emergency births as "home birthing".

So, is home birthing with midwives is as safe for low risk mothers as in-hospital ones?

Andrew Grimm
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  • I am puzzled by your final comment - medicated? Home births can have all the same medication as hospital births. The only area of additional risk is if something goes wrong - where a hospital has Emergency facilities and your house doesn't. Having tried both home and hospital births my wife says home is much less stressful - for low risk mothers. – Rory Alsop Apr 28 '12 at 17:32
  • I think the only fair comparison would be for low risk births. No one suggests a home birth is safe for high risk births - eg the farm has great stats but they insist on hospital births for high-risk pregnancies. As do all mainstream midwives. consider making this distinction in the question – David LeBauer Apr 29 '12 at 02:51
  • Yes, include in the question itself for clarity, because the rest is context. – David LeBauer Apr 29 '12 at 03:36
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    so according to http://www.naturalbirthandbabycare.com/farm-statistics.html, in 4.9% of cases transport to hospital was required. Not exactly what I'd call risk free. – vartec May 01 '12 at 08:19
  • I've edited the question a bit, partially because I'm not sure I quoted the person on my twitter feed correctly, and partially because some of the content didn't add that much specific information to the question. – Andrew Grimm May 01 '12 at 12:51
  • @vartec It is important to understand the statistic in context. At the farm, only 5% of patients required medical intervention. At the hospital, the intervention rate is much higher (e.g. 1/3 have cesareans, most get epidurals). All hospital births require transport to the hospital, whereas only 5% of farm births do. On the other hand, the demographics, history, health, wealth, and risk levels of patients at the farm is not representative of patients who go to hospitals. So there is really no fair comparison. – David LeBauer May 03 '12 at 00:07
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    @David: "At the farm, only 5% of patients required medical intervention.", no, at farm 5% patients required medical intervention **beyond** that of qualified midwife, and needed to be transported **to hospital**. And of course there is high rate of medical intervention in hospitals. That's what they are for. – vartec May 03 '12 at 08:18
  • @vartec thanks for the clarification - you are certainly correct. I did not mean to imply that the farm does not use medical intervention at all. I meant to say that the farm does not use epidurals or perform cesareans. Both of these interventions are common and often optional. For example, cesareans are often used in a hospital after two hours of pushing, even if no other symptoms are observed. – David LeBauer May 03 '12 at 15:36
  • I'd be nervous about sourcing statistics and references from midwifery organisations and other home birth proponents, as there are plenty of examples of them distorting the statistics. – Jon Marnock Sep 26 '12 at 01:07
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    Also, safe for whom? The mother or the baby? – Jon Marnock Sep 26 '12 at 01:15
  • @JonKloske "I'd be nervous about sourcing statistics and references" - you could say I'm *skeptical* about it. "safe for whom?" - mainly the mother, primarily because maternal deaths can generally be attributed to the birth process, whereas neonatal deaths may be unrelated to the birth process. – Andrew Grimm Sep 26 '12 at 03:10
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    @AndrewGrimm Yeah, I think if you ignore the safety of the baby, and only choose low risk mothers, and make sure there's emergency transport and available hospital facilities in the event something goes wrong, then maternal safety can be about as good as hospital birthing. However, in my mind that's a hell of a lot of caveats for something, especially when as far as I can tell the only benefits are higher maternal satisfaction with the process... As far as the baby goes it's less clear I think, but early trend is less safe. Can turn this into an answer if you like :) – Jon Marnock Sep 28 '12 at 02:08
  • depending on the hospital, not going there might in some cases be more healthy... – jwenting Oct 04 '12 at 07:22
  • @jwenting are you joking, or serious? – Andrew Grimm Oct 04 '12 at 08:35
  • @AndrewGrimm, of course it's more healthy not to go to the hospital. Statistically speaking, hospitals are very dangerous places where many people die ;). This just to illustrate the caveat of statistics. – gerrit Oct 04 '12 at 08:48
  • @AndrewGrimm quite serious, sadly. While we'd like our hospitals to be examples of great care, hygiene, and expertise, such is often not the case (and depending on where you are, may rarely be the case). In such cases it's better to be at home. – jwenting Oct 04 '12 at 13:19

2 Answers2

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No, home birth is substantially more likely to result in the death of the baby, even with a qualified homebirthing midwife.

Most of the pro-homebirth articles and studies focus on the reduction in medical interventions taken for the mother (cessarians, etc), which I will leave to the reader to decide if that's more important than the life of the baby.

References:

http://www.sciencebasedmedicine.org/index.php/home-birth-safety/

More and more American women (1 in 200) are opting for home birth, and midwife-assisted home birth is common in other developed countries. How safe is it compared to birth in a hospital? A new study sheds some light on the subject. It was recently published in the American Journal of Obstetrics and Gynecology: Maternal and newborn outcomes in planned home birth vs planned hospital births: a metaanalysis, by Wax et al. ...

RESULTS: Planned home births were associated with fewer maternal interventions including epidural analgesia, electronic fetal heart rate monitoring, episiotomy, and operative delivery. These women were less likely to experience lacerations, hemorrhage, and infections. Neonatal outcomes of planned home births revealed less frequent prematurity, low birthweight, and assisted newborn ventilation. Although planned home and hospital births exhibited similar perinatal mortality rates, planned home births were associated with significantly elevated neonatal mortality rates.

CONCLUSION: Less medical intervention during planned home birth is associated with a tripling of the neonatal mortality rate.

(emphasis mine) (Perinatal mortality refers to stillbirths or deaths up to 7 days, neonatal mortality refers to deaths up to 28 days).

Similar findings from the 2003-2004 CDC data (the US birth certificate was revised in 2003 to include the location and attendant at the birth): http://www.sciencebasedmedicine.org/index.php/the-tragic-death-toll-of-homebirth/

Neonatal mortality rate

CNM = Certified Nurse Midwife (hospital birth), DEM = Direct Entry Midwife (home birth)

Other related articles:

Community
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BradC
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    A personal anecdote: My wife and oldest child would both likely be dead if we hadn't been in a hospital, just down the hall from an operating room. We weren't previously aware of any risk factors. – BradC Oct 03 '12 at 22:35
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    One note, this shows that they are more likely to die between 8-28 days. This could be explained by the fact that many who choose home birth also do not take their children for well baby checkups. I think this explains the data better than assuming the increase death rate is caused by home birth. Remember that correlation does not equal causation. In this case, it well may be a common cause. – William Grobman Oct 04 '12 at 03:34
  • I didn't dig deep enough to see if any of the studies adjusted for those factors, @WilliamGrobman, I suppose it's possible. But I think the discrepancy is more likely to be due to actual medical problems experienced in home births where emergency care couldn't be administered quickly, resulting in a baby hanging on life support for a couple weeks. We'd probably have to drill into the details of the actual deaths to know for sure. – BradC Oct 04 '12 at 15:07
  • that would be really interesting to investigate. I could easily see both having a substantial affect on the neonatal mortality rate. I'm not sure which would be the larger contributor though. To estimate their relative magnitudes, it would be interesting to compare the fraction of neonatal hospital deaths with 7+ days of life support to the fraction of well baby checkup refusing home birthers and estimates of how effective at reducing mortality neonatal care is. – William Grobman Oct 04 '12 at 16:51
  • Read the full article at the first link, the author discusses the "why neonatal deaths and not perinatal deaths" question a bit. I looked, though, and didn't see any mention of the lack of well-baby follow-ups, so if that is any factor at all, that study doesn't appear to address it. – BradC Oct 04 '12 at 20:56
  • The key statistic for me from the first article is that 37% of attempted home deliveries (on the first pregnancy) end up with an emergency transport to a hospital. You have to imagine that in some of these cases, time is of the essence to save the baby or the mother. The author of the article concludes, "I submit that delayed treatment of unexpected emergencies constitutes a small but undeniable risk for planned home births. It has not been established that the benefits of home birth (lower maternal infection rate, etc.) can outweigh that risk." – BradC Oct 04 '12 at 20:59
  • I'll see your anecdote and raise you two: all three of my children were born at home, no issues. –  Mar 11 '19 at 20:35
  • No, this study does NOT show that home birth is less safe - it does shows that home birth is associated with higher death rates (only after 7 days), but it does not explain _why_, in particular not whether the higher death rates are caused by the decision to home-birth. The classic "correlatioin does not imply causation" thing. The article you linked admits that the study raises more questions than it answers: "Perinatal mortality was similar, but neonatal mortality was significantly greater. This is puzzling and [...] " – sleske Jun 24 '20 at 07:24
  • Also note the conclusion of the actual study: " Less medical intervention during planned home birth is _associated_ with a tripling of the neonatal mortality rate" (emphasis mine). – sleske Jun 24 '20 at 07:30
  • @sleske You are correct, correlation doesn't absolutely prove causation, but in this case I don't see any other rational conclusion; choosing a home birth appears to mean a higher risk that the baby will not survive. (For example, there's no evidence that more mothers with high-risk pregnancies choose home births; in fact the opposite is more likely true.) And I don't think the "why" is hard to figure out, either; it's even implied by the conclusion you quote: if quick medical intervention is not available if/when a problem occurs, then in at least some cases, the baby will not survive. – BradC Jun 24 '20 at 14:24
  • @BradC: You raise good arguments - I just wanted to point out that the study does not provide evidence for the claimed causal link. In particular, while home birth is most likely more risky than hospital birth, we simply do not know how big the risk is, so the claim "home birth is substantially more likely to result in the death of the baby" is not backed by evidence - and that's what skeptics.SE is about. – sleske Jun 25 '20 at 06:51
  • @sleske I think I'm OK with "substantially more likely", its pretty close to the study's phrasing of "*significantly elevated* neonatal mortality rates". Note also my second link shows a mortality rate *two to three times* higher for planned home births (1.15 vs 0.61 and 1.15 vs 0.37), so we *do* have at least some evidence to suggest how big the risk is. Clearly, the vast majority of home births (and hospital births) are trouble-free, the difference comes in the (thankfully) small percent of cases when something goes wrong. – BradC Jun 25 '20 at 13:57
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The subject is matter of debate, at least in The Netherlands, where home-birthing is very common. A Dutch-language blog article links to a number of studies which different conclusions. In 2010, a study was published concluding that homebirthing is more risky:

  • Perinatal mortality and severe morbidity in low and high risk term pregnancies in the Netherlands: prospective cohort study, Annemieke C C Evers et al, BMJ 2010; 341:c5639 / doi: 10.1136/bmj.c5639

However, the study was criticised at a number of points. From

Given the limitations of the study, the conclusion that labour starting in primary care carries a higher risk of delivery related perinatal death compared to labour starting in secondary care is premature from a scientific point of view.

So, it's probably not at all easy to answer the question.

gerrit
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