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Home Versus Hospital Delivery
The medical literature offers some encouraging news about the option of delivering at home. A handful of studies, most published since 1995, attest to the safety and effectiveness of home deliveries.
These studies attribute a variety of positive results to midwife-managed care. In one study, the risk of infant and neonatal death and the likelihood of delivering a low-birth-weight baby were lower in midwife-attended births, compared with physicianattended births. Another study found that women in midwife-attended deliveries were less likely to undergo a cesarean section and that fewer diagnoses of fetal distress were made.
In total, the studies point to less intervention in midwife- assisted deliveries. A 1996 study in The Lancet found that labor was initiated less often in women attended by midwives only than in women attended by physicians and midwives. Significantly more women were satisfied with the midwife-managed care than with the care managed by a physician and midwife.
The results of this study show that the pregnancy outcome of women who delivered their first baby at home is as good as that of women who gave birth to their first baby in the hospital. On the other hand, women who gave birth to at least one child and planned to deliver at home had significantly better pregnancy outcomes than those who planned to deliver in the hospital, indicating that home delivery is as safe, or safer, than hospital delivery.
—Wiegers TA, Keirse MJ, van der Zee J, Berghs GA, Outcome of planned home and planned hospital births in low risk pregnancies: prospective study in midwifery practices in The Netherlands. BMJ 1996 Nov 23; 313(7068):1309-13.
This letter was written in reply to an article published on the Times of May 20, describing hospital delivery as being 3 times safer than home delivery. The letter emphasizes that the author of the Times article compared data from different countries to reach his conclusions, although data were actually not comparable. Evaluation of the National Birthday Trust survey of home births in the U.K., a certainly more appropriate approach to the question of safety of home versus hospital delivery, shows that within a group formed by 3,896 women who delivered at home, there was only one neonatal death (occurring from 0 to 27 days after birth) and no stillbirths, compared to 2 neonatal deaths and 2 stillbirths in a control group of similar, low-risk women who delivered in the hospital. The author concludes that there is no evidence indicating that home delivery carries more risk than hospital delivery in properly screened women. The letter emphasizes that women should receive accurate, up-to-date information, so that they may properly choose between home and hospital delivery.
—Chamberlain G, Choosing between home and hospital delivery. Risk of home birth in Britain cannot be compared with data from other countries. Letter. BMJ 2000; 320:798 (18 March).
This randomized study, conducted on 1,299 low-risk pregnant women, evaluated pregnancy outcome in women attended by midwives only, or by a combination of midwives, hospital doctors and general physicians. Labor was initiated significantly more often in women followed by physicians and midwives than in those followed by midwives only (33.3% vs. 23.9% of cases). Women attended only by midwives were more likely to have an intact perineum and less likely to undergo episiotomy (surgical enlargement of the vulval orifice during delivery). Perineal tears and rate of complications were similar in the two groups. Significantly more women expressed satisfaction with the midwife-managed care than with the physician-midwife managed care.
—Turnbull D, et al., Randomised, controlled trial of efficacy of midwife-managed care. Lancet 1996 Jul 27; 348(9022):213-8.
The results of this study, conducted on all women who in 1991 delivered by the vaginal route a single baby at 35-43 weeks gestation, show that the risk of infant and neonatal death is 19% and 33% lower, respectively, in midwife-attended births compared to physician-attended births. The likelihood of delivering a low-birth-weight infant is 31% lower in midwife- versus physician-assisted deliveries. These results suggest that delivery care provided by midwives may be superior to that provided by physicians.
—MacDorman MF, Singh GK, Midwifery care, social and medical risk factors, and birth outcomes in the USA. J Epidemiol Community Health 1998 May; 52(5):310-7.
The results of this study show that women attended by midwives are 30% less likely to undergo cesarean section compared to those attended by physicians. Furthermore, a diagnosis of fetal distress is made 50% less often in babies delivered by midwives, compared to those delivered by physicians.
—Butler J, Abrams B, Parker J, Roberts JM, Laros RK Jr., Supportive nurse-midwife care is associated with a reduced incidence of Cesarean section. Am J Obstet Gynecol 1993 May; 168(5):1407-13.
The results of this study show that pregnancy outcomes in women whose pregnancy has been followed by midwives are similar to those of women followed by obstetricians, indicating that routine visits of low-risk pregnant women by obstetricians are unnecessary. Women who experienced complications during labor were promptly recognized by midwives and transferred to obstetrician care.
—Law YY, Lam KY, A randomized controlled trial comparing midwife-managed care and obstetrician-managed care for women assessed to be at low risk in the initial intrapartum period. J Obstet Gynaecol Res 1999 Apr; 25(2):107-12.
The results of this study show that pregnancy outcomes in women who choose to deliver at home and are attended by midwives are similar to those of women who choose to deliver in hospital and are attended by obstetricians. Women who delivered at home received significantly less medication and fewer medical interventions, compared to those who delivered in the hospital. In the case of complications or suspected complications, women were transferred to the hospital and were followed up by obstetricians.
—Ackermann-Liebrich U, et al., Home versus hospital deliveries: follow up study of matched pairs for procedures and outcome. Zurich Study Team. BMJ 1996 Nov 23; 313(7068):1313-8.
By Gary Null, Ph.D., Debora Rasio, M.D. and Martin Feldman, M.D.
References: www.garynull.com
About the Author:
Gary Null, nationally syndicated talk show host & producer of PBS specials, is a consumer advocate, investigative reporter, NY Times best-selling author and an award-winning documentary filmmaker. Gary believes that, "You must be empowered before you can be whole," and he empowers all who will listen with life-changing facts that promote wellness.
Gary has conducted over a hundred major investigations and has produced numerous documentaries in which he encourages his viewers to take charge of their lives and health. Among his dozens of videos are titles like "The Pain, Profit and Politics of AIDS," "Chronic Fatigue," "Diet for a Lifetime, and "Cancer, A Natural Approach."
Gary Null lives the active, healthful life that he advocates. He regularly competes in races and marathons and has trained thousands of people in his "Natural Living Walking and Running Club "to do the same."
 This article appeared in Pathways to Family Wellness magazine, Issue #01.
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