Safety of planned home birth is not supported by evidence

Abstract Background: Home birth is still considered an unusual situation on most developed countries, where it accounts between 0.2 and 25 percent of all births depending of the country. However, the safety of the process and whether it should be offered as a choice makes it a controversial topic with strong opinions on both sides. This review aims to describe the situation of home birth in several developed countries and debate its safety and mothers’ satisfaction, by reviewing studies that compare home vs. hospital births.Methods: A systematic research has been done using different search engines to find publications that portray the current situation on this topic. Protocols and historical facts were selected using no filters, while publications reporting maternal and birth outcomes, as well as levels of satisfaction, were selected using filters that limited the search to articles that had been published in the last 10 years. A total of 45 articles were selected and reviewed.Results: Home birth in each country depends on many factors, including historical and cultural. Some countries have either developed good practice guidelines or included home birth on the already existing ones, while some other countries still do not recognize it as a safe option. While most studies do not show significant differences on neonatal mortality APGAR score and intensive care admissions, they do describe slightly better maternal outcomes on home birth due to lower interventionism. Studies also show that between 13 and 29 percent of home births require transferring the woman or the fetus to the hospital. Satisfaction levels also appear to be higher in women who had a planned home birth.Conclusions: Home birth appears to be a safe choice for women with low risk pregnancies, due to a lower rate of interventionism. However, safety depends on many factors, from professional accreditation, to the presence of protocols and good practice guidelines. Satisfaction also appears to be higher on women who had a planned home birth, although it depends on personal considerations and circumstances.

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The Canadian birth place study: examining maternity care provider attitudes and interprofessional conflict around planned home birth

10.32920/14636766.v1 ◽

2021 ◽

Author(s):

Saraswathi Vedam ◽

Kathrin Stoll ◽

Laura Schummers ◽

Nichole Fairbrother ◽

Michael C Klein ◽

...

Keyword(s):

Care Provider ◽

Home Birth ◽

Outcome Variable ◽

Categorical Variables ◽

Provider Type ◽

Provider Attitudes ◽

Home Births ◽

Birth Place ◽

Obstetric Emergencies ◽

Planned Home Birth

Background Available birth settings have diversified in Canada since the integration of regulated midwifery. Midwives are required to offer eligible women choice of birth place; and 25-30% of midwifery clients plan home births. Canadian provincial health ministries have instituted reimbursement schema and regulatory guidelines to ensure access to midwives in all settings. Evidence from well-designed Canadian cohort studies demonstrate the safety and efficacy of midwife-attended home birth. However, national rates of planned home birth remain low, and many maternity providers do not support choice of birth place. Methods In this national, mixed-methods study, our team administered a cross-sectional survey, and developed a 17 item Provider Attitudes to Planned Home Birth Scale (PAPHB-m) to assess attitudes towards home birth among maternity providers. We entered care provider type into a linear regression model, with the PAPHB-m score as the outcome variable. Using Students’ t tests and ANOVA for categorical variables and correlational analysis (Pearson’s r) for continuous variables, we conducted provider-specific bivariate analyses of all socio-demographic, education, and practice variables (n=90) that were in both the midwife and physician surveys. Results Median favourability scores on the PAPHB–m scale were very low among obstetricians (33.0), moderately low for family physicians (38.0) and very high for midwives (80.0), and 84% of the variance in attitudes could be accounted for by care provider type. Amount of exposure to planned home birth during midwifery or medical education and practice was significantly associated with favourability scores. Concerns about perinatal loss and lawsuits, discomfort with inter-professional consultations, and preference for the familiarity of the hospital correlated with less favourable attitudes to home birth. Among all providers, favourability scores were linked to beliefs about the evidence on safety of home birth, and confidence in their own ability to manage obstetric emergencies at a home birth. Conclusions Increasing the knowledge base among all maternity providers about planned home birth may increase favourability. Key learning competencies include criteria for birth site selection, management of obstetric emergencies at planned home births, critical appraisal of literature on safety of home birth, and inter-professional communication and collaboration when women are transferred from home to hospital.

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