About Pregnancy and Birth
A good midwife makes giving birth at home as safe as in hospital
April
16, 2009
Researchers in the
Netherlands say
giving birth at home with a midwife is as safe as doing so in
hospital. The researchers say a home birth assisted by a
trained midwife is just as safe for low-risk mothers and their
babies as a delivery led by a midwife in hospital.
The team from the TNO Institute for Applied Scientific Research
carried out a study of 529,688 low-risk women who were in the care
of a midwife at the start of labour - of these women 321,307 (60.7%)
planned to give birth at home and 163,261 (30.8%) planned to give
birth in hospital and for 45,120 (8.5%), the intended place of birth
was unknown.
The nationwide study set out to compare home and planned hospital
births, among low-risk women who started their labour in primary
care and the team found over a seven year period that there was no
difference in death or serious illness among either mothers or their
babies if they gave birth at home rather than in hospital.
Concerns about the safety of home births has always been an issue
and obstetricians have welcomed the study but say it may not apply
universally.
The research was carried out after figures showed the country had
one of the highest rates in Europe of babies dying during or just
after birth and home births were suspected of being a factor.
In Holland home birthing is an option which is encouraged and a
third of mothers choose to have their baby this way and the research
revealed that among "low-risk" women who planned to give birth at
home there was no difference in death or serious illness rates among
either babies or mothers.
Professor Simone Buitendijk who led the research says they found
that for low-risk mothers at the start of their labour it is just as
safe to deliver at home with a midwife as it is in hospital with a
midwife.
Professor Buitendijk says the results should strengthen policies
that encourage low-risk women at the onset of labour to choose their
own place of birth.
In the study low-risk were deemed to be those who had no known
complications such as a baby in breech or one with a congenital
abnormality, or a previous Caesarean section.
Of women in the study, almost a third who planned and started their
labours at home ended up being transferred as complications arose,
such as an abnormal fetal heart rate, or if the mother needed more
effective pain relief in the form of an epidural.
In many countries the health system is not set up to meet an
increase in a potential demand for home births and the researchers
emphasize the importance of both highly-trained midwives who know
when to refer a home birth to hospital as well as the availability
of rapid transportation to get a mother into hospital if necessary.
The researchers say while the study was the most comprehensive yet
into the safety of home births, they also acknowledged that the
group who chose to give birth in hospital rather than at home were
more likely to be first-time mothers or of an ethnic minority
background and the risk of complications is higher in both these
groups.
The study also did not compare the relative safety of home births
against low-risk women who opted for doctor rather than midwife-led
care and say this will be the subject of a future investigation.
Professor Buitendijk says the study has relevance for other
countries with a highly developed health infrastructure and
well-trained midwives.
The researchers say the study shows that planning a home birth does
not increase the risks 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.
The UK government has pledged to give all women the option of a home
birth by the end of this year - currently 2.7% of births in England
and Wales take place at home - but critics say changes will be
needed in the way maternity services are organised and a major
increase in the number of midwives, before that can be realized.
The Royal College of Obstetricians and Gynaecologists (RCOG) said it
supported home births in cases of low-risk pregnancies provided the
appropriate infrastructures and resources are present to support
such a system but women need to be counseled on the unexpected
emergencies which can arise during labour, such as cord prolapse,
fetal heart rate abnormalities, undiagnosed breech, prolonged labour
and postpartum hemorrhage - which can arise during labour and can
only be managed in a maternity hospital.
The RCOG says such emergencies would always require the transfer of
women by ambulance to the hospital as extra medical support is only
present in hospital settings and would not be available to them when
they deliver at home.
The study has been welcomed by midwives and home-birth advocates in
Australia and is expected to put further pressure on the Federal
Government to review and update maternity services.
The Australian College of Midwives reportedly says there is ample
evidence that mothers have higher satisfaction rates when giving
birth at home, but concerns about the impact on the baby had seen
home birth remain under question.
However the Royal Australian and New Zealand College of
Obstetricians and Gynaecologists warned caution is called for in
comparing the Dutch experience to Australia as they say pregnant
women are cared for very differently in the two countries.
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