Patricia Janssen and colleagues compared perinatal outcomes for planned home births attended by midwives (862 births) and for planned hospital births attended by either physicians (743) or midwives (571). The authors found that more women in the home birth group than in the midwife-attended hospital group had an intact perineum (55.0% v. 44.1%). The incidence of maternal infection was lower in the home birth group than in either the physician-attended or midwife-attended hospital groups (0.7% v. 3.5%). The authors also report that neonatal outcomes included similar rates of meconium aspiration in all groups and 3 perinatal deaths (0.3%) in the home birth group, 1 (0.1%) in the physician-attended group and none in the midwife-attended hospital group. Five babies (0.6%) in the home birth group required ventilator assistance for at least 24 hours, as compared with none in either comparison group.
The data suggest that there is no increased risk associated with planned midwife-attended home births, but the authors recommend ongoing evaluation of rare, but serious, adverse outcomes, including hemorrhage, death and the need for ventilator support.
In a related commentary, Régis Blais praises the study for providing “valuable information” about the safety of home births. Blais also recommends close monitoring of adverse outcomes of home births in the future.
p. 315 Outcomes of planned home births versus planned hospital births after regulation of midwifery in British Columbia — P.A. Janssen et al
p. 335 Are home births safe? — R. Blais
Contact: Dr. Patricia Janssen, Department of Family Practice, University of British Columbia, Vancouver; tel. 604 822-0363
Dr. Régis Blais, Groupe de recherche interdisciplinaire en santé, Université de Montreal; tel. 514 343-5907, email: regis.blais@umontreal.ca
Canadian Medical Association Journal