The media tend to portray childbirth as a high-risk event where anything could go wrong at any time. It is therefore not surprising that most of us feel that the safest labor and birth setting is the hospital, where we can be constantly monitored for problems and an operating room and surgical staff are available in case anything goes wrong.
But the reality is that most complications that occur in labor and birth are predictable. They tend to occur in women with high-risk pregnancies, develop slowly, or are known side effects of labor interventions such as medications to strengthen contractions or reduce pain. Although urgent complications can occur without advance warning, these are the exception rather than the rule.
Still, many women wonder if home birth can be as safe as hospital birth. Researchers have been studying this question for decades. Until recently, virtually every study suffered from major flaws that resulted in promising data but no clear answer to the safety question.
More recently, three studies have been published that meet the highest standard for home birth research. One of these, a study from the Netherlands, where home birth is common, looked at the outcomes of more than a half-million planned home births. These studies show no difference in death or serious injury to babies and much better outcomes for mothers in planned home births.
Importantly, the three recent studies came from countries where only healthy women at term, with no risk factors for complications, may plan home births. In addition, midwives in these settings are highly skilled and regulated and have established relationships with consultant physicians and hospitals, so women or babies who need hospitalization can access it easily.
For these reasons, the outcomes of the studies cannot necessarily be applied to the United States, where there are no standard eligibility requirements for planned home birth. Laws regulating midwifery vary across the United States, and some midwives work without any formal arrangements for consultation and referral. Still, the largest study of planned home births in the United States showed excellent outcomes for both mothers and babies with low rates of obstetric complications, although the study did not meet the rigorous standards of other studies because hospital data on low-risk women in the United States are inadequate.
In about 10 percent of home births, the mother or infant requires transfer from the home to a hospital to access specialized procedures or care. In these instances, good communication and coordination between providers is vital. The Home Birth Consensus Summit, a collective of physicians, midwives and childbirth advocates, has developed a set of evidence-based guidelines to improve outcomes and increase collaboration between all those involved in serving women who are planning home births.
In practice, the safety of home birth depends on the health of the woman and fetus, the skill of the home birth care provider, the distance to a hospital, and the ability to get safe, timely care at that hospital should a complication develop.