Home births generally safe, but transfer to hospital increases risk for baby
Publication Date:03/04/2008
Home births are getting more popular, and while they're generally safe, specialised hospital care is further away in an emergency. New research shows that there's a higher risk of a baby dying if a mother who has planned a home birth is transferred from home to hospital.
What do we know already?
Most women have a choice of where they give birth. Options include a hospital, a maternity unit in the local community, or at home.
The majority of women still have their babies in hospital, although home births are becoming more popular and the government has said that all soon-to-be mothers will have a choice by next year. Some types of pain relief, such as an epidural, aren't available at home and your doctor might advise going to hospital if there's a risk of complications, but a home birth is a valid option for many women.
While the majority of home births go smoothly, unexpected complications can mean a transfer to hospital. To see how safe home births are for babies, researchers have looked at what happened to all the babies born in England and Wales between 1994 and 2003.
What does the new study say?
It's rare for babies to die during birth in the UK, wherever they are born. Overall, in the 10 years of the study, less than 1 (0.79) in 1,000 babies died during or soon after childbirth. For women who chose a home birth and went on to have the baby at home without problems, the risk of the baby dying was even lower (0.48 in 1,000). This isn't that surprising, since women who choose home births will normally have been assessed by their doctors as being at low risk.
Women who planned to give birth at home but ended up going into hospital had a higher risk of losing their baby. Just over 6 in 1,000 babies died when a transfer to hospital was needed. The study doesn't tell us why women who planned a home birth went into hospital, although signs that the baby isn't doing well (foetal distress) is a common reason. Other reasons may include a change of heart, or a desire for stronger pain relief. One problem with the study is that it does not compare this figure with the number of women who planned to give birth in hospital and whose babies died because of complications.
The researchers also say that while overall death rates for babies have been falling, there's been no improvement in the death rates for booked home birth.
Where does the study come from?
The study was done by researchers from the National Collaborating Centre for Women's and Children's Health. It was published in BJOG: An International Journal of Obstetrics and Gynaecology, which is produced by a company called Blackwell.
What does this mean for me?
The research suggests that home births are likely to be safe for most women who have a normal healthy pregnancy, but there is a note of caution. The safety of booked home births doesn't seem to be improving as quickly as the overall safety rate. And there's a greater danger to babies if there's a transfer from home to hospital.
What should I do now?
The decision about where to have your baby is down to you, but your doctor can advise you on the benefits and risks of whichever option you choose.
You'll almost certainly be advised to go to hospital if your baby is likely to be born prematurely, or there's a chance he or she will need special care. You'll also have a wider choice of pain relief if you give birth in hospital.
If you're planning a home birth, it's important to get all the support you need. Make sure you ask your doctor or midwife what your risk of complications is likely to be, and what plans are in place in case you need to go to hospital.
From:
Mori R, Dougherty M, Whittle M. An estimation of intrapartum-related perinatal mortality rates for booked home births in England and Wales between 1994 and 2003. BJOG: An International Journal of Obstetrics and Gynaecology. 2008; 115: 554-559.
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