Last week the American College of Obstetricians and Gynecologists (ACOG) issued a press release announcing the publication of Committee Opinion Number 476, Planned Home Birth questioning the safety of home birth based on a discredited and highly criticized study by lead author J.R. Wax. The Opinion states that babies are two-to-three times more likely to die when women give birth at home. This is not the first time that ACOG has attempted to discredit the safety of home birth without supporting evidence.
“Although the Committee on Obstetric Practice believes that hospitals and birthing centers are the safest setting for birth,” states ACOG, “it respects the right of a woman to make a medically informed decision about delivery. Women inquiring about planned home birth should be informed of its risks and benefits based on recent evidence. Specifically, they should be informed that although the absolute risk may be low, planned home birth is associated with a twofold to threefold increased risk of neonatal death when compared with planned hospital birth.”
ACOG’s opinion is based on a faulty study not “recent evidence.” Even more egregious, ACOG is recommending to its members to spread this misinformation to their own patients.
In a commentary on the Wax study written for the Birth Journal Marc J.N.C. Keirse, MD, a member of the editorial team responsible for preparing Effective Care in Pregnancy and Childbirth notes,
“Home birth has attracted a great deal of attention of late, culminating in a meta-analysis to assess its risks for mother and baby. Mothers were estimated to be 2.6 times more likely to die and babies 3 times more likely to die from a planned home birth than from a planned hospital birth. The actual data on which these estimates were based demonstrate that meta-analysis can be developed into an art that suits whatever purpose its authors hope to achieve. Combining studies of home versus hospital, without differentiating what is inside them, where they are, and what is around them, is akin to producing a fruit salad with potatoes, pineapples, and celery.”
ACOG states that hospitals are the safest place to give birth for all women. However, according to the Centers for Disease Control and Prevention (NVSS Vol.58, Number 11, March 3, 2010) low risk women who plan a home birth have fewer preterm and low birthweight babies. For low-risk women who gave birth between 1990 and 2006 the low birthweight (less than 2,500 grams) rate was 5.2% for planned home births compared with 8.3% for hospital births. For preterm (less than 37 weeks of gestation) births the rate was 7.2% for home births compared to 12.9% for hospital births.
Home Birth is Safe When Four Important Criteria are Met
Planned home birth is as at least as safe as planned hospital birth for similar groups of women when four important criteria are in place.
1. Pregnant women are low risk.
2. Home was chosen as the intended place for birth.
3. The primary care provider is qualified according to professional licensing standards and trained to assist at home births.
4. A collaborative relationship with consulting physicians and a medical center exists with clear guidelines for continuity of care should a complication arise where the mother or baby would benefit from the transfer.
Based on a review of 16 years of scientific studies on home birth the Coalition for Improving Maternity Services Expert Work Group found that compared to low risk women who plan a hospital birth, low risk women who plan a home birth have similar or better outcomes with fewer medical interventions and fewer cesareans. The researchers found several health advantages to giving birth at home for both mothers and their infants.
Women who gave birth at home had the same or lower rates of induction and augmentation of labor. They were less likely to need IV fluids, to have an amniotomy (intentional breaking of the bag of waters), or to have continuous electronic fetal monitoring. (Routine continuous electronic monitoring and amniotomy are associated with an increased risk for cesarean section.) At home women had more freedom of movement and more choice of positions for labor and birth. Ultimately the home birth group had fewer cesareans and more VBACs, less or similar incidents of maternal infection requiring antibiotics after birth, and less need for a blood transfusion.
Perinatal outcomes from the planned home births were similar to planned hospital births. Similar rates of newborns were admitted to the intensive care unit and similar or fewer numbers of newborns suffered from birth traumas. The number of babies who died in the first twenty-weight days (perinatal mortality) was similar in the home birth and hospital birth groups. Overall 85 % of women who first gave birth in a hospital and went on to have a home birth preferred their experience of birth at home. Nine out of ten women who planned to have other children said they would have another home birth.
Evidence supporting the safety of home birth is freely available on several websites including the American College of Nurse Midwives, the Midwives Alliance of North America and The Big Push for Midwives.
Undoubtedly, this unfounded opinion on the dangers of home birth is likely to cause some alarm. However, given that expectant mothers actively search the internet for information on pregnancy and birth women can be trusted to access the accurate information they need to make an informed choice about home birth.