Low-risk women opting for a planned home birth have no increased risk of severe adverse maternal outcomes – and in some cases show improved outcomes – show researchers.
Dutch researchers looked at 146,752 low-risk women in primary care at the onset of labour in this two-year cohort study. Patients in this study either had a planned home birth (62.9%) or planned hospital birth (37.1%). The main outcome measures were severe acute morbidity (admission to an intensive care unit, eclampsia, blood transfusion of four or more packed cells, and other serious events), postpartum haemorrhage and manual placenta removal.
For nulliparous women (44%), the rate of severe acute morbidity for planned home versus planned hospital birth was 2.3 versus 3.1 per 1,000 births, postpartum haemorrhage rate was 43.1 versus 43.3 per 1,000 births respectively, and the rate of manual placenta removal was 29.0 versus 29.8 per 1,000 births. For parous women (56%), the rate of severe acute morbidity for planned home versus planned hospital birth was 1.0 versus 2.3 per 1,000 births; postpartum haemorrhage rate was 19.6 versus 37.6 per 1,000 births and the rate of manual placenta removal was 8.5 versus 19.6 per 1,000 births. This difference was statistically significant in parous women.
What this means for GPs
The researchers concluded: ‘We found no evidence that planned home birth among low-risk women leads to an increased risk of severe adverse maternal outcomes in a maternity care system with well trained midwives and a good referral and transportation system.’