Screenshot of Saraswathi Vedam's presentation, "Home or Hospital: Holding the Space for Human Birth" at TEDxAmherstCollege (YouTube video)

Homebirth Papers

On this page, you can find a list of research, studies, meta analyses, reviews,  summaries, etc. on home birth to date. If you know of a paper not listed here, please contact [email protected] to have it included.

1996

Healthy low risk women who wish to deliver at home have no increased risk either to themselves or to their babies.

  • BMJ. 1996 Nov 23;313(7068):1313-8.
    Home versus hospital deliveries: follow up study of matched pairs for procedures and outcome. Zurich Study Team.
    Ackermann-Liebrich U1, Voegeli T, Günter-Witt K, Kunz I, Züllig M, Schindler C, Maurer M.

The outcome of planned home births is at least as good as that of planned hospital births in women at low risk receiving midwifery care in the Netherlands.

  • BMJ. 1996 Nov 23;313(7068):1309-13.
    Outcome of planned home and planned hospital births in low risk pregnancies: prospective study in midwifery practices in The Netherlands.
    Wiegers TA1, Keirse MJ, van der Zee J, Berghs GA.

1997

Home birth is an acceptable alternative to hospital confinement for selected pregnant women, and leads to reduced medical interventions.

2005

Planned home birth for low risk women in North America using certified professional midwives was associated with lower rates of medical intervention but similar intrapartum and neonatal mortality to that of low risk hospital births in the United States.

  • BMJ. 2005 Jun 18;330(7505):1416.
    Outcomes of planned home births with certified professional midwives: large prospective study in North America.
    Johnson KC1, Daviss BA.

2007

Although most women in the United States give birth in hospitals, a substantial body of research suggests that planned home birth or birth in freestanding birth centers have equally good or better outcomes for low-risk women. Out-of-hospital birth often facilitates mother-friendly care. Rationales and systematic reviews of both home birth and freestanding birth center birth are presented.

2008

  • MIDIRS Midwifery Digest. 2008;18(3):376–385.
    Safety of planned home births: An NCT review of evidence.
    Gyte G, Dodwell M.

In Sweden, between 1992 and 2004, the intrapartum and neonatal mortality in planned home births was 2.2 per thousand. The proportion is higher compared to hospital births but no statistically significant difference was found. Women in the home birth group more often experienced a spontaneous birth without medical intervention and were less likely to sustain pelvic floor injuries.

  • Acta Obstet Gynecol Scand. 2008;87(7):751-9. doi: 10.1080/00016340802199903.
    Outcome of planned home births compared to hospital births in Sweden between 1992 and 2004. A population-based register study.
    Lindgren HE1, Rådestad IJ, Christensson K, Hildingsson IM.

2009

This study shows that planning a home birth does not increase the risks of perinatal mortality and severe perinatal morbidity among low-risk women, provided the maternity care system facilitates this choice through the availability of well-trained midwives and through a good transportation and referral system.

  •  BJOG. 2009 Aug;116(9):1177-84. doi: 10.1111/j.1471-0528.2009.02175.x.
    Perinatal mortality and morbidity in a nationwide cohort of 529,688 low-risk planned home and hospital births.
    de Jonge A1, van der Goes BY, Ravelli AC, Amelink-Verburg MP, Mol BW, Nijhuis JG, Bennebroek Gravenhorst J, Buitendijk SE.

Planned home birth attended by a registered midwife was associated with very low and comparable rates of perinatal death and reduced rates of obstetric interventions and other adverse perinatal outcomes compared with planned hospital birth attended by a midwife or physician.

  •  CMAJ. 2009 Sep 15;181(6-7):377-83. doi: 10.1503/cmaj.081869. Epub 2009 Aug 31.
    Outcomes of planned home birth with registered midwife versus planned hospital birth with midwife or physician.
    Janssen PA1, Saxell L, Page LA, Klein MC, Liston RM, Lee SK.

The most common reasons given for wanting to birth at home were: 1) safety (n = 38); 2) avoidance of unnecessary medical interventions common in hospital births (n = 38); 3) previous negative hospital experience (n = 37); 4) more control (n = 35); and 5) comfortable, familiar environment (n = 30). Another dominant theme was women’s trust in the birth process (n = 25). Women equated medical intervention with reduced safety and trusted their bodies’ inherent ability to give birth without interference.

Midwives who were integrated into the health care system with good access to emergency services, consultation, and transfer of care provided care resulting in favorable outcomes for women planning both home or hospital births.

  • Birth. 2009 Sep;36(3):180-9. doi: 10.1111/j.1523-536X.2009.00322.x.
    Outcomes associated with planned home and planned hospital births in low-risk women attended by midwives in Ontario, Canada, 2003-2006: a retrospective cohort study.
    Hutton EK, Reitsma AH, Kaufman K.

2011

Women planning to give birth in secondary and tertiary hospitals had a higher risk of cesarean section, assisted modes of birth, and intrapartum interventions than similar women planning to give birth at home and in primary units. The risk of emergency cesarean section for women planning to give birth in a tertiary unit was 4.62 (95% CI: 3.66-5.84) times that of a woman planning to give birth in a primary unit. Newborns of women planning to give birth in secondary and tertiary hospitals also had a higher risk of admission to a neonatal intensive care unit (RR: 1.40, 95% CI: 1.05-1.87; RR: 1.78, 95% CI: 1.31-2.42) than women planning to give birth in a primary unit.

  • Birth. 2011 Jun;38(2):111-9. doi: 10.1111/j.1523-536X.2010.00458.x. Epub 2011 Mar 10.
    Planned place of birth in New Zealand: does it affect mode of birth and intervention rates among low-risk women?
    Davis D, Baddock S, Pairman S, Hunter M, Benn C, Wilson D, Dixon L, Herbison P.

The results support a policy of offering healthy women with low risk pregnancies a choice of birth setting. Women planning birth in a midwifery unit and multiparous women planning birth at home experience fewer interventions than those planning birth in an obstetric unit with no impact on perinatal outcomes. For nulliparous women, planned home births also have fewer interventions but have poorer perinatal outcomes.

  • BMJ. 2011 Nov 23;343:d7400. doi: 10.1136/bmj.d7400.
    Perinatal and maternal outcomes by planned place of birth for healthy women with low risk pregnancies: the Birthplace in England national prospective cohort study.
    Birthplace in England Collaborative Group, Brocklehurst P, Hardy P, Hollowell J, Linsell L, Macfarlane A, McCourt C, Marlow N, Miller A, Newburn M, Petrou S, Puddicombe D, Redshaw M, Rowe R, Sandall J, Silverton L, Stewart M.

2012

Even after adjustment for known confounders such as parity, the odds of postpartum haemorrhage (≥1000ml of blood lost) are significantly higher if a hospital birth is intended than if a home birth is intended (odds ratio 2.5, 95% confidence interval 1.7 to 3.8). The ‘home birth’ group included women who were transferred to hospital during labour or shortly after birth.

  • BMC Pregnancy Childbirth. 2012 Nov 19;12:130. doi: 10.1186/1471-2393-12-130.
    Comparing the odds of postpartum haemorrhage in planned home birth against planned hospital birth: results of an observational study of over 500,000 maternities in the UK.
    Nove A, Berrington A, Matthews Z.

Increasingly better observational studies suggest that planned hospital birth is not any safer than planned home birth assisted by an experienced midwife with collaborative medical back up, but may lead to more interventions and more complications.

2014

Five themes emerged from the women’s narratives: 1) choices and empowerment: with home birth, women felt they were given real choices rather than perceived choices, giving them feelings of empowerment; 2) interventions and interruptions: women believed things were done that were not helpful to the birth process, and there were interruptions associated with their hospital births; 3) disrespect and dismissal: participants believed that during hospital birth, providers were more focused on the laboring woman’s uterus, with some experiencing dismissal from their hospital provider when choosing to birth at home; 4) birth space: giving birth in their own home, surrounded by people they chose, created a peaceful and calm environment; and 5) connection: women felt connected to their providers, families, newborns, and bodies during their home birth.

women that choose a publicly-funded home birth service describe strong influences that led them to home birth within this model of care. Service managers and health professionals need to acknowledge the importance of place of birth choice for women.

  • Midwifery. 2014 Jul;30(7):892-8. doi: 10.1016/j.midw.2014.03.003. Epub 2014 Mar 12.
    The influences on women who choose publicly-funded home birth in Australia.
    Catling C, Dahlen H, Homer CS.

2016

Fifteen cohort studies were included. Two studies of low‐risk births and two including higher risk births found home births to be at an increased risk of neonatal mortality. However, mortality is rare in developed nations and may not be the best measure of safety. When studies focused on low‐risk pregnancies, planned birth location, and well‐trained birth attendants, there was no difference in neonatal morbidity (Apgar score and NICU admission).

  • Jpn J Nurs Sci. 2016 Jul;13(3):297-308. doi: 10.1111/jjns.12116. Epub 2016 Jan 28.
    Investigating the debate of home birth safety: A critical review of cohort studies focusing on selected infant outcomes.
    Elder HR, Alio AP, Fisher SG.

2018

Spontaneous delivery was significantly higher in PHB than PHos group (OR: 2.075; 95%CI:1.654-2.063) group. Women in PHB group were less likely to undergo cesarean section compared with women in PHos (OR:0.607; 95%CI:0.553-0.667) group. PHB group was less likely to receive medical interventions than PHos group. The risk of fetal dystocia was lower in PHB than PHos group (OR:0.287; 95%CI:0.133-0.618). The risk of post-partum hemorrhage was lower in PHB than PHos group (OR:0.692; 95% CI.0.634-0.755). The two groups were similar with regard to neonatal morbidity and mortality.

High-quality evidence about low-risk pregnancies indicates that place of birth had no statistically significant impact on infant mortality. The lower odds of maternal morbidity and obstetric intervention support the expansion of birth centre and home birth options for women with low-risk pregnancies.

  • Midwifery. 2018 Jul;62:240-255. doi: 10.1016/j.midw.2018.03.024. Epub 2018 Apr 3.
    Maternal and perinatal outcomes by planned place of birth among women with low-risk pregnancies in high-income countries: A systematic review and meta-analysis.
    Scarf VL, Rossiter C, Vedam S, Dahlen HG, Ellwood D, Forster D, Foureur MJ, McLachlan H, Oats J, Sibbritt D, Thornton C, Homer CSE.

2019

results show that among low risk women who intend to give birth at home when labour starts there is no increase in perinatal and neonatal mortality or morbidity compared to similarly low risk women who intend to give birth in a hospital. There were no differences between intended home and intended hospital groups in other neonatal outcomes including NICU admission, Apgar scores, and the need for resuscitation.

  • The Lancet. Volume 14, P59-70, September 01, 2019. doi.org/10.1016/j.eclinm.2019.07.005.
    Perinatal or neonatal mortality among women who intend at the onset of labour to give birth at home compared to women of low obstetrical risk who intend to give birth in hospital: A systematic review and meta-analyses.
    Eileen K. Hutton, Angela Reitsma, Julia Simioni, Ginny Brunton, Karyn Kaufman

NOTES:

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