Is home birth safe?

Is home birth safe?  This is a question I am often asked when I discuss the options for birth to expectant parents.  My answer is yes, for the majority of women, home birth is a safe option, however only around 2.4% of births take place in the home, compared to 33% in the 1960s.  

In 2019, a review published in The Lancet analysed 14 studies with data from 500,000 intended home births.  The study found that there was no difference in the risk of perinatal or neonatal mortality for intended home births, compared to hospital births.  Further evidence published in 2020 reported low-risk women - intending to birth at home - experienced less interventions such as operative vaginal birth (forceps or ventouse), epidural analgesia, episiotomy and Caesarean section.  Furthermore, maternal infections, postpartum haemorrhages and third and fourth degree tears were less likely for women intending home births.  

Choosing a home birth can also improve the experience of transitioning to parenthood for many parents.  A Norwegian study published in 2020 found that the care received during a planned home birth, promoted physiological labour and birth and the positive experience developed confidence with the transformative process of parenthood and other aspects of the participants' life.

NICE (National Institute for Health and Care Excellence) recommends that women with a low chance of labour and birth complications should be able to choose from all four birth settings (home, freestanding midwifery unit, alongside midwifery unity and obstetric unit. The Birthplace study in 2011 found women deemed ‘higher risk' who planned birth in a midwifery-led setting, as opposed to an obstetric unit as is recommended by national clinical guidelines, had a lower chance of maternal interventions and adverse outcomes that required obstetric care. However there appeared to be more hospital admissions for babies. It is unclear whether there was an actual complication or if the babies were transferred into hospital ‘just in case’.

The next question I am asked is what if there is an emergency?  Midwives are experts in the physiological process of birth which enables birth to unfold.  As discussed previously, the likelihood of situations requiring interventions are reduced when birth is in the home.  However midwives carry equipment and have the skills and training to manage emergencies at a home birth and will liaise with the obstetric unit and ambulance service for transfer to hospital.  It is important to note, the findings of the Birthplace study, reported the most frequent reason to transfer to hospital for a first time mother, was not for an emergency but for slow progress in labour.

Local home birth groups are a wonderful way to learn more and meet other parents who are planning a home birth or have experienced one.