Home births fall due to access to midwives
THE NUMBER of Irish women having home births has fallen – down from 245 in 2001 to 168 in 2011, according to the most recent figures.
The fall is partly linked to the problems women faced in many parts of the country getting access to a midwife who will assist in the home birth.
Obstetricians remain divided on the issue of home births, and studies have so far been too small to compare severe maternal complications between planned home and planned hospital births among low-risk women.
However, a new study shows that women with low-risk pregnancies who choose to give birth at home have a lower risk of severe complications than women who plan a hospital birth.
However, the authors stress that the overall risk of severe problems is small and the results are significant only for women who have previously given birth – not for first-time mums.
The relative safety of planned home births is a topic of continuous debate, but studies have so far been too small to compare severe maternal complications between planned home and planned hospital births among low-risk women.
Of all Western countries, the Netherlands has the highest percentage of home births, assisted by a primary-care midwife.
So a team of Dutch researchers decided to test whether low-risk women at the onset of labour with planned home birth have a higher rate of rare but severe outcomes (known as severe acute maternal morbidity or SAMM) than those with planned hospital births.
This was defined as admission to an intensive care unit, uterine rupture, eclampsia or major obstetric haemorrhage (requiring a large blood transfusion), according to the 'British Medical Journal'. Other adverse complications included postpartum haemorrhage (severe loss of blood after delivery) and manual removal of the placenta.
Using data from a national study into maternal morbidity and national birth registry data from August 1, 2004 to August 1, 2006, they identified more than 146,000 low-risk women in primary care at the onset of labour.
Results were adjusted for several factors, including gestational age, maternal age, ethnic background and socioeconomic status.
Of the 146,752 women included in the study, 92,333 (63pc) had a planned home birth and 54,419 (37pc) a planned hospital birth.
For women having their first baby (nulliparous women), the rate of severe outcomes for a planned home birth was 2.3 per 1,000 compared with 3.1 per 1,000 for a planned hospital birth.
The rate of postpartum haemorrhage was 43.1 per 1,000 for a planned home birth compared with 43.3 per 1,000 for a planned hospital birth.
For women who had previously given birth (parous women), the rate of severe outcomes for a planned home birth was one per 1,000 compared with 2.3 per 1,000 for a planned hospital birth.
The rate of postpartum haemorrhage was 19.6 per 1,000 for a planned home compared with 37.6 per 1,000 for a planned hospital birth.
Adverse outcomes were less common among planned home than among planned hospital births but differences were only statistically significant for women who had previously given birth.
The researchers emphasise that their findings may only apply to regions where midwives are well trained to assist women at home births and where facilities for transfer of care and transportation in case of emergencies are adequate.
Health & Living