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Home birth; safe birth

Updated: May 2, 2019

A little bit of history.

Did you know that the big move from home birth to hospital happened after a government report in 1970? I was born in 1968, at home, which was the norm then. Even breech and twins were considered normal to birth at home. The number of hospital births had increased since the advent of the NHS, but still the majority happened at home.

The Peel report in 1970 linked the reduction in perinatal mortality figures since the war to the increase in hospital births and the Minister for Health decreed that hospitals should make the provision for 100% of births to take place in hospital. The conclusion was that home birth was dangerous.

In the late 1970s statistician Marjorie Tew set her undergraduate medical students the task of proving that hospitals were the safest place to give birth. When every single one of them found the opposite she was perplexed, and went off to check it out herself. She published her findings in 'Safety in Childbirth': an abridged version is available from the AIMS website.

Tew found that statistics for home births often included unplanned home births, such as premature births, or undisclosed pregnancies. These tend to have worse outcomes. When the unplanned home births were separated out the outcomes for planned home births were at least as good as hospital births.

She found that it was the improvement in living standards that was the likely cause of the reduction in neonatal mortality as the poorest, those still living in poverty, had not had any improvement in neonatal mortality.

Trawling through decades of statistics she found that planned home birth was at least as safe as hospital for all except the most high risk group: so for low risk, medium risk, moderately high risk, women and babies did at least as well at home.

But it was too late. The seed had been sown. Home birth rates had plummeted in the 1970s and in the early 80s was around 1%.

Further studies, such as the Birthday Trust Study in 1994, the Birth Place study in 2011, and the Netherlands study in 2015, have all shown planned home birth is associated with much lower levels of interventions, fewer cases of poor outcomes for women (tearing/episiotomy, haemorrhage), and at least as good outcomes for babies (when comparing like with like). (See my note about first babies and the Birth Place Study below.)

Studies have also found there are benefits for women with higher risk factors with a planned home birth, including those with previous caesarean and high BMI.

Today the rate of home birth nationally is around 2%. However, there is huge variation. Some areas, such as Northern Ireland have much lower rates and some areas, that have really promoted home birth, have rates of 20+%.

There is good news. The Better Births initiative called for women to have better access to all their birth place options, and the promotion of out of hospital births for low risk women. It is starting to see increased efforts to promote home birth, with some areas having dedicated home birth teams, and others caseloading teams providing continuity of carer, which often leads to an increase in home births.

Home birth isn't for everyone. But everyone should consider it as an option.

Home birth is amazing! As someone who has had four out of my five babies at home, and who has supported women and couples at home births and hospital births, there is no contest. Home birth is not just a different, more relaxing experience. It is a completely different thing. Birth happens differently at home. The atmosphere, the tempo, the baby.

Home birth is a safe and sensible option.

(Read this my birth story for this baby HERE.)

I am a doula and antenatal teacher. You can find more about home birth here.

I run home birth webinars, a free hbac course (home birth after caesarean) and a local home birth group.

Note about first babies: The standard measure for poor outcome is usually the number of babies who died/were admitted to neonatal care, and Apgar scores. The birth place study says that perinatal mortality is so rare that it is hard to find a difference between the settings, so it created an amalgamated 'poor outcome', which included perinatal mortality, admission to neonatal care, along with some other conditions which are not long term and not necessarily life threatening such as broken clavicle and meconium aspiration syndrome.

It found that there was a significantly higher, though still small, chance of this poorer outcome with planned home birth for first babies. However standalone birth centres had the lowest rate and they have no greater access to medical care, nor quicker transfer times to hospital. No explanation was given for this discrepancy. I did ask a researcher from the team and they pointed me towards their research that showed that areas with high levels of midwifery confidence in home birth had lowest rates of transfer, suggesting it is the midwives' confidence that makes the difference.

The Netherlands study was much bigger (700,000 births) so should be big enough to identify differences found no difference in perinatal mortality, Apgar scores, nor admittance to neonatal unit for first timers with planned home birth. Their conclusion was that home birth is safe for first timers.

The links for all these studies is here.

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