Midwives in Ontario, Canada, have been providing care for expectant mothers in both home and hospital settings. They have been integrated into the provincial health-care system since 1994.
A recent study by McMaster University researchers reveals that low-risk women giving birth with the assistance of midwives have positive outcomes regardless of where the delivery takes place.
The findings of the study are published in the print and online editions of the journal Birth. It concludes that home birth is as safe as hospital delivery.
Almost 6,700 planned home births in Ontario were assessed in the study. Results indicated that newborns and mothers were no more likely to suffer complications than their counterparts in a clinical setting.
Eileen Hutton, the lead investigator of the study and assistant dean of midwifery at McMaster University said: “Home birth has been huge debated over the last 40 to 50 years.”
“As birth made its way into hospital without any clear evidence that it was a safer place to be, home birth has become more and more discouraged. I think for women who want to make that choice, it’s important to have good information about those aspects of care.”
Hutton and a team of researchers examined records of women who had planned home or hospital births between 2003 and 2006. They used an electronic database of midwifery care compiled by the Ontario Ministry of Health and Long-Term Care.
The researchers compared 6,692 home birth women with 6,692 hospital birth women. Both groups were at low risk for complications. Findings suggested that the risk of death was very low for mother and child in both the hospital and home settings. The mortality rate was one per 1,000 live births in both cases. No maternal deaths were reported in either group.
The study examined the occurrence of serious complications, such as death, need for immediate medical care after birth, neonatal resuscitation, admission to a pediatric intensive care unit and low birth weight. It was lower in the home birth group (2.3 percent) compared to the hospital group (2.8 percent). It was also the case for all interventions with 5.2 percent home birth compared to 8.1 percent hospital, including cesarean section.
In conclusion, the authors explain that the variations between the hospital and home birth groups are most probably due to the differences between women who make the choice to give birth at home compared to those who select the hospital.
Hutton, associate professor in the Department of Obstetrics and Gynecology of the Michael G. DeGroote School of Medicine remarks: “Women who plan a home birth are often more motivated to avoid interventions such as epidurals, which reduce the potential for other interventions.”
“It is also plausible that the setting itself influences the outcomes. Being in one’s own home environment may go beyond mere comfort and enhance the very process of labour and birth.”
The criteria for home birth are set by the College of Midwives of Ontario. Ineligible women for home birth include:
• Twin pregnancy
• Breech or medically complicated pregnancies
• Women with more than one previous cesarean section
• Women with gestation less than 37 weeks
• Women with gestation more than 43 weeks at the onset of birth
Throughout the study period, around 130,000 births per year were reported in Ontario. Midwives attended about 8,600 of those births annually.
“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”
Eileen K. Hutton, Angela H. Reitsma, Karyn Kaufman
DOI: 10.1111/j.1523-536X.2009.00322.x
Birth
Written by Stephanie Brunner (B.A.)