Study finds homebirths safe as hospital births in low-risk pregnancies

A homebirth is just as safe as a hospital birth for healthy women with low-risk pregnancies, a Victorian study has found.

But for high-risk pregnancies, including women who’ve had a previous c-section, the study revealed the rate of stillbirth or neonatal death was up to seven times higher during homebirth.

“In women with normal pregnancies, there were no differences in the rates of perinatal death between those who planned a homebirth and hospital birth,” lead researcher and epidemiologist at Hudson Institute of Medical Research, Dr Miranda Davies-Tuck, said.

“However, for women with risk factors, the rates of stillbirth or neonatal death were significantly higher in women who had planned a homebirth.”

High risk factors include:

  • Multiple pregnancy (such as twins or triplets)
  • Post-term pregnancy (after 42 weeks gestation)
  • Obesity
  • Non-head-first presentation of the baby at birth (a shoulder-first or feet-first/ breech birth)
  • Prior caesarean
  • Previous uterine surgery
  • More than five previous births
  • Any significant maternal medical condition, such as: diabetes (including gestational diabetes), high blood pressure, or heart, kidney, liver, respiratory, hormone-related, immune or gastrointestinal disease.

The study, which involved the Consultative Council for Obstetric and Paediatric Mortality and Morbidity, Hudson Institute of Medical Research, Monash University and Safer Care Victoria, delved into data on all babies born in Victoria at 37 weeks plus, between 2000 and 2015.

It found that for healthy women who have had a healthy pregnancy, homebirth was linked to lower rates of intervention, like unplanned c-sections, epidural and episiotomy than similar women who gave birth in hospital.

But for those with pregnancy complications, the study found having their baby in hospital is significantly safer.

“Healthy women who planned a homebirth with a midwife experienced lower rates of obstetric interventions and some maternal morbidities than women planning hospital births,” Dr Davies-Tuck said.

“However, outcomes for homebirth are not equal for all women, particularly those with high-risk pregnancies, and women should speak with their GP, obstetrician or registered midwife when making choices around planned place of birth. For high-risk women, giving birth in hospital is the safer choice for their baby.”

Homebirth in Australia

newborn baby mother si

Only 0.3 per cent of women plan a homebirth in Australia, compared to 3.4 per cent of women in New Zealand, two per cent in Canada and the UK, and 20 per cent in the Netherlands.

Dr Davies-Tuck believes a lack of evidence on Australian homebirth outcomes is to blame.

“The evidence in this study will help Australian women in making informed choices about where to have their baby, as well as assisting health services and policy makers,” Dr Davies-Tuck said.

“For homebirth to be safest, current evidence and guidelines indicate women should be attended by at least one midwife in the early stages of labour, and two midwives at the time of birth and few hours after birth,” she added.