Is homebirth safe? This question has been a topic of intense debate for almost a century. So, what do the studies indicate? What insights does the research provide? What do women who have experienced high-quality midwifery care share? With the right parameters, yes! A low-risk homebirth can be a very safe alternative to a planned hospital birth. When I mention parameters, I refer to women who desire a planned homebirth and are categorized as low-risk. It’s essential for them to find a provider with the necessary skill and experience to accommodate their unique health, background, wishes, and needs. Additionally, there should be timely access to advanced medical care if the situation demands it. A midwife should possess skills in emergency medical management while waiting for emergency services to arrive.
The relationship between a woman and her midwife should be a partnership built on openness, communication, and a shared commitment to follow sound advice and care for both herself and her growing baby. Many studies and reviews, including a significant systematic review and meta-analysis from 2019, consistently show that "the risk of perinatal or neonatal mortality was not different when birth was intended at home or in hospital."
A large study by MANA (Midwives Alliance of North America) involving 16,924 women planning a home birth yielded impressive results. Low-risk women in this sample experienced high rates (93.6%) of normal physiologic birth with very low rates of operative births and interventions, and no associated increase in adverse events. It’s important to note that these women chose an out-of-hospital birth, were low-risk, and selected providers suitable for their circumstances.
Are the machines that beep necessary? For some, yes! Some women feel more secure with technological advancements nearby. Sometimes, a woman's health or pregnancy may not be suitable for an out-of-hospital birth. Midwifery embraces time-tested methods and skills that have often been overshadowed by modern maternity care's reliance on technology and rigid protocols. This medical protocol does not account for each individual woman's specific situation. Midwifery care emphasizes relationships with the mother, her unborn baby, and her support circle; intuition; and understanding of the mother's feelings regarding her body and baby. While most midwives do utilize modern medical tools like lab work and ultrasounds, it's essential to recognize that these should not replace the invaluable skills that midwives possess. Women who seek out midwifery care value these tools and the lower interventions they often provide. This does not imply that midwives lack training to manage serious situations such as hemorrhage or assist a newborn in transitioning to breathing after birth.
At some point, midwifery fell out of favor and became stigmatized. The culturally accepted environment for birth shifted to hospitals. Consequently, midwifery became misunderstood, and a woman’s right to choose where she feels safe to give birth faced challenges. Here we are a century later, still grappling with the same question: Is homebirth safe? Is hospital birth safe? There is never a black-and-white answer. Ultimately, women should feel secure with the environment and care providers they select, as this is a crucial factor in overall birth safety. Some women feel safest in a hospital surrounded by immediate medical interventions, while others feel more secure at home with focused one-on-one care in a familiar environment. Safety encompasses more than just physical aspects; feeling safe can contribute to a more positive emotional experience and potentially a quicker delivery.
Where and with whom a woman gives birth should be her choice.
Also see the page, Safer Birth In a Barn?
1. 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 Hutton, Eileen K. et al., eClinicalMedicine, Volume 14, 59 - 70