Research and Articles

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The most relevant studies and articles

Study: Perinatal or neonatal mortality among women intending to give birth at home at the start of labor compared with low-risk women intending to give birth in a hospital: A systematic review and meta-analyses

In 2019, a large systematic review and meta-analysis was published in The Lancet. It included 14 studies with data from 500,000 planned home births. The result was:

“The risk of stillbirth, neonatal mortality or morbidity was not different when birth was intended at home or in hospital” (Hutten en at. 2019).

For those of you who want to know more details, this study showed the following:

“Among nulliparous women intending a home birth in settings where midwives attending home birth are well-integrated in health services, the odds ratio (OR) of perinatal or neonatal mortality compared to those intending hospital birth was 1.07 (95% Confidence Interval [CI], 0.70 to 1.65); and in less integrated settings 3.17 (95% CI, 0.73 to 13.76). Among multiparous women intending a home birth in well-integrated settings, the estimated OR compared to those intending a hospital birth was 1.08 (95% CI, 0.84 to 1.38); and in less integrated settings was 1.58 (95% CI, 0.50 to 5.03).”

“Women who are low risk and who intend to give birth at home do not appear to have a different risk of fetal or neonatal loss compared to a population of similarly low risk women intending to give birth in hospital.”

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. 2019. eClinicalMedicine

https://doi.org/10.1016/j.eclinm.2019.07.005

Study: Maternal outcomes and birth interventions among women starting labor intending to give birth at home compared with low-risk women intending to give birth in a hospital: A systematic review and meta-analyses

Safety for mom

Is it safe for the mother to give birth at home? The same data set produced several articles, including those on maternal outcomes and the need for medical assistance during labor. The study found:

“Among low-risk women, those intending to birth at home experienced fewer birth interventions and untoward maternal outcomes.” (Reitsma A et.al. 2020)

For those of you who want more details:

“There were no reported maternal deaths. When controlling for parity in well-integrated settings we found women intending to give birth at home compared to hospital were less likely to experience caesarean section OR 0.58(0.44,0.77); operative vaginal birth OR 0.42(0.23,0.76); epidural analgesia OR 0.30(0.24,0.38); episiotomy OR 0.45(0.28,0.73); 3rd or 4th degree tear OR 0.57(0.43,0.75); oxytocin augmentation OR 0.37(0.26,0.51) and maternal infection OR 0.23(0.15,0.35). Pooled results for postpartum haemorrhage showed women intending home births were either less likely or did not differ from those intending hospital birth [OR 0.66(0.54,0.80) and RR 1.30(0.79,2.13) from 2 studies that could not be pooled with the others]. Similar results were found when data were stratified by parity and by degree of integration into health systems.”

Maternal outcomes and birth interventions among women who begin labour intending 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. Reitsma A et.al 2020 eClinicalMedicine.

https://pubmed.ncbi.nlm.nih.gov/32280941/

Article: Home Birth in the Netherlands

The Netherlands has a long tradition of offering home birth care - although fewer give birth at home now than 20-30 years ago, around 15% still choose to give birth at home. Therefore, the Netherlands has a wealth of data on this topic.

The study by Jonge et al. (2009) included nearly 530,000 healthy women - of which 321,307 (60.7%) planned a home birth, 163,261 (30.8%) planned a hospital birth, and 45,120 (8.5%) had an unknown birth plan. Their conclusion was:

“Planning a home birth does not increase the risks of perinatal mortality and severe perinatal morbidity among low-risk women, provided the maternity care system facilitates this choice through the availability of well-trained midwives and through a good transportation and referral system.” (Jonge, A. et.al 2009)

Perinatal mortality and morbidity in a nationwide cohort of 529.688 low risk planned home and hospital births. de Jonge, A. et.al. (2009) BJOG: An International Journal of Obstetrics & Gynaecology, 116: 1177-1184. https://doi.org/10.1111/j.1471-0528.2009.02175.x

Studies often span many years, and update articles and new studies are produced. De Jonge et al. wanted to examine a larger data set from several databases. In 2015, they formulated the following conclusion:

"We found no increased risk fo adverse perinatal outcomes for planned home births among low-risk women. Our results may only apply to regions where home birhts are well integrated into the maternity care system"

Perinatal mortality and morbidity up to 28 days after birth among 743 070 low risk planned home and hospital births: a cohort study based on three merged national perinatal databases. A de Jonge et.al - BJOG Vol 122 (5) 2015. 720-728 https://doi.org/10.1111/1471-0528.13084

Article: Home Birth in Norway and the Nordic countries

In Norway, home births are not organized through the public healthcare system. If you want to give birth at home, you must find one or two midwives who can offer this service privately, and there are few midwives who can work exclusively with home births, both economically and practically. A midwife is on call for several weeks, which affects the ability to take on other work and maintain family life. Most home birth midwives in the last few decades have not had many births per year—however, there are exceptions, such as midwife Anett Michelsen in Ås, who has delivered nearly 800 babies at home over the past 30 years. There have also been studies on home births in Norway:

llen Blix et al. published a cohort study in 2012: Outcomes of planned home birth and planned hospital births in low-risk women in Norway between 1990 and 2007: A retrospectiv cohort study, Ellen Blix et.al 2012. https://doi.org/10.1016/j.srhc.2012.10.001

“Data from 1631 planned home births between 1990 and 2007 were compared with a random sample of 16,310 low-risk women with planned hospital births. The primary outcomes were intrapartum intervention rates and complications. Secondary outcomes were perinatal and neonatal death rates.”

“Planning for home births was associated with reduced risk of interventions and complications. The study is too small to make statistical comparisons of perinatal and neonatal mortality.”

For those of you who want a bit more details:

“Primiparas who planned home births had reduced risks for assisted vaginal delivery (OR 0.32; 95% CI 0.20–0.48), epidural analgesia (OR 0.21; CI 0.14–0.33) and dystocia (OR 0.40; CI 0.27–0.59). Multiparas who planned home births had reduced risks for operative vaginal delivery (OR 0.26; CI 0.12–0.56), epidural analgesia (OR 0.08; CI 0.04–0.16), episiotomy (OR 0.48; CI 0.31–0.75), anal sphincter tears (OR 0.29; CI 0.12–0.70), dystocia (OR 0.10; CI 0.06–0.17) and postpartum hemorrhage (OR 0.27; CI 0.17–0.41). We found no differences in cesarean section rate. Perinatal mortality rate was 0.6/1000 (CI 0–3.4) and neonatal mortality rate 0.6/1000 (CI 0–3.4) in the home birth cohort. In the hospital birth cohort, the rates were 0.6/1000 (CI 0.3–1.1) and 0.9/1000 (CI 0.5–1.5) respectively.”

The right treatment at the right time

Collaboration between home and hospital

When hospital transfer is necessary

Research and experience show us that planned home births for healthy women and babies are safe. The safety lies in a relational care model where the midwife and family get to know each other during pregnancy, where the midwife monitors the health of the mother and baby, and where one can transfer to the next level of medical care if needed during the process.

How many of the planned home births in the Nordic countries require transfer to a hospital during or after birth? This likely depends on many factors, such as the midwife's experience, organization, collaboration with hospitals, and certainly the preparations and assessments made before birth. The study by Blix et al. (2012) aimed to find this out:

“Women planning a home birth are transferred to hospital in case of complications or elevated risk for adverse outcomes. The aim of the present study was to describe the indications for transfer to hospital in planned home births, and the proportion of cases in which this occurs”.

“One-third of all nulliparous and 8.0% of multiparous women were transferred during labor or within 72 h of the birth. The most common indication for transfers during labor was slow progress. In transfers after birth, postpartum hemorrhage, tears, and neonatal respiratory problems were the most common indications. A total of 116 (3.8%) of the 3068 women had transfers classified as potentially urgent.”

Transfers to hospital in planned home birth in four Nordic countries – a prospective cohort study. Blix E, Kumle MH, Ingversen K,

Huitfeldt AS, Hegaard HK, Ólafsdóttir ÓÁ, et al. Acta Obstet Gynecol Scand 2016; 95: 420–428. DOI: 10.1111/aogs.12858

Does increased medicalization lead to better outcomes?

A summary article written by senior researcher Ole Olsen, Research Unit for General Practice, together with midwife and PhD Jette Aaroe Clausen, describes their findings as follows:

“A 2023 summary of the best available research published in the internationally recognized Cochrane Library shows that planned hospital births can do more harm than good. This applies if the pregnant woman is healthy, expects an uncomplicated birth, and the birth takes place in a well-organized health care system. Evidence from observational studies suggests that planned hospital birth does not reduce mortality but may lead to more interventions, more complications, and more neonatal problems.”

“The World Health Organization (WHO) has raised concern that the increasing medicalization of childbirth tends to undermine women’s own capability to give birth and negatively impacts their childbirth experience.”

Read the researchers’ summary at https://publichealth.ku.dk/news/hospital-births-can-do-more-harm-than-good/

Read the Cochrane review which highlights the lack of RCT evidence and the need for a different approach at https://www.cochranelibrary.com/cdsr/doi/10.1002/14651858.CD000352.pub3/full

Several advantages of home birth

There are many studies that also highlight other advantages of home births. One example is this study from Ireland and England:

“Home birth was found to be significantly associated with breast feeding at all examined time points, including at birth, 8 weeks, 6 months and breast feeding exclusively at 6 months.” Association between home birth and breast feeding outcomes: a cross-sectional study in 28 125 mother–infant pairs from Ireland and the UK | BMJ Open

A birth naturally also affects the partner of the pregnant woman, and here we refer to a study from Ireland. They found the following:

“Participants’ overall experience scores were significantly higher for homebirth (9.7/10) than hospital birth (5.5/10).”

“Homebirth was perceived far more positively than hospital birth experiences across all aspects of care surveyed.”

“This study provides evidence regarding the need for genuine choices for maternity care and reveals the importance of care which is respectful and responsive to divergent ideologies about birth.” (Gregory et al 2023).

“It could not have been more different.” Comparing experiences of hospital-based birth and homebirth in Ireland: A mixed-methods survey - Women and Birth

25 years of ABC birth care

We had great success with the care model during ABC’s 25-year history. The pregnant woman and her partner developed a relationship with the midwife over time throughout the pregnancy. They also met the other midwives, ensuring predictability and a secure environment when labor started. This care model creates a relational bond between the birthing couple and the midwife. We have further developed this at Min Fødsel and believe it provides the best conditions for experiencing safety, predictability, and positive outcomes for new families.

Are midwife continuity of care models versus other models of care for childbearing women better for women and their babies? | Cochrane

The pendulum is shifting

In our neighboring countries, the pendulum regarding home births has also begun to swing back, and more women are choosing to give birth at home if the option is available. In Denmark, women can choose to give birth at home through a public home birth program. The home birth service is therefore free, and 3.3% (2022) plan to give birth at home. However, the Danish system does not ensure continuity through pregnancy, birth, and postpartum in the capital region. Continuity with a 'known midwife' is practiced in several places in Jutland, by private home birth midwives, and at the independent midwifery clinic. https://roskildefoedeklinik.dk/

For the first time in 50 years, 5.5% (2023) of births in Iceland take place outside of institutions. They have a financial system where 'the money follows the woman,' meaning that private home birth midwives are paid for follow-up, on-call time, and the birth itself. In Norway, midwives receive specific fees for the actual birth assistance, but follow-up, home visits, and on-call time are not covered by the public system. For women to have a real choice regarding home births, the state should ensure that midwives can offer this service free of charge.

Planning for a home birth is not suitable for everyone. It is important that we have different options for women and their families, taking into account their wishes and needs. For some, it is best to give birth at home, while for others, it is best to give birth in a hospital. We hope that you, as a reader, find your way and what suits you best."

Is it safe to give birth at home?

The most relevant studies and articles

Collaboration between home and hospital

More relevant studies

The pendulum is shifting

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