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I came across the following page, describing "The Farm"'s midwifery statistics: http://www.naturalbirthandbabycare.com/farm-statistics.html

That page wasn't that convincing. The only statistic that it directly compared against conventional birthing is the rate at which caesarian section is performed. That fewer c-sections are done is marvellous, but it doesn't prove that it's safe.

However, I clicked on a link from that page to http://www.naturalbirthandbabycare.com/home-birth.html , which talks about a paper published in BMJ: Outcomes of planned home births with certified professional midwives: large prospective study in North America. That paper doesn't seem to be looking at maternal mortality, but says that other research has already shown that home birthing for low risk mothers has similar safety to low risk hospital mothers.

http://www.naturalbirthandbabycare.com/home-birth.html also claims that studies showing home birthing for low risk mothers has a higher risk include counting unplanned emergency births as "home birthing".

So, is home birthing with midwives is as safe for low risk mothers as in-hospital ones?

  • I am puzzled by your final comment - medicated? Home births can have all the same medication as hospital births. The only area of additional risk is if something goes wrong - where a hospital has Emergency facilities and your house doesn't. Having tried both home and hospital births my wife says home is much less stressful - for low risk mothers. – Rory Alsop Apr 28 '12 at 17:32
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    so according to naturalbirthandbabycare.com/farm-statistics.html, in 4.9% of cases transport to hospital was required. Not exactly what I'd call risk free. – vartec May 1 '12 at 8:19
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    @David: "At the farm, only 5% of patients required medical intervention.", no, at farm 5% patients required medical intervention beyond that of qualified midwife, and needed to be transported to hospital. And of course there is high rate of medical intervention in hospitals. That's what they are for. – vartec May 3 '12 at 8:18
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    Also, safe for whom? The mother or the baby? – Jon Kloske Sep 26 '12 at 1:15
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    @AndrewGrimm Yeah, I think if you ignore the safety of the baby, and only choose low risk mothers, and make sure there's emergency transport and available hospital facilities in the event something goes wrong, then maternal safety can be about as good as hospital birthing. However, in my mind that's a hell of a lot of caveats for something, especially when as far as I can tell the only benefits are higher maternal satisfaction with the process... As far as the baby goes it's less clear I think, but early trend is less safe. Can turn this into an answer if you like :) – Jon Kloske Sep 28 '12 at 2:08
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No, home birth is substantially more likely to result in the death of the baby, even with a qualified homebirthing midwife.

Most of the pro-homebirth articles and studies focus on the reduction in medical interventions taken for the mother (cessarians, etc), which I will leave to the reader to decide if that's more important than the life of the baby.

References:

http://www.sciencebasedmedicine.org/index.php/home-birth-safety/

More and more American women (1 in 200) are opting for home birth, and midwife-assisted home birth is common in other developed countries. How safe is it compared to birth in a hospital? A new study sheds some light on the subject. It was recently published in the American Journal of Obstetrics and Gynecology: Maternal and newborn outcomes in planned home birth vs planned hospital births: a metaanalysis, by Wax et al. ...

RESULTS: Planned home births were associated with fewer maternal interventions including epidural analgesia, electronic fetal heart rate monitoring, episiotomy, and operative delivery. These women were less likely to experience lacerations, hemorrhage, and infections. Neonatal outcomes of planned home births revealed less frequent prematurity, low birthweight, and assisted newborn ventilation. Although planned home and hospital births exhibited similar perinatal mortality rates, planned home births were associated with significantly elevated neonatal mortality rates.

CONCLUSION: Less medical intervention during planned home birth is associated with a tripling of the neonatal mortality rate.

(emphasis mine) (Perinatal mortality refers to stillbirths or deaths up to 7 days, neonatal mortality refers to deaths up to 28 days).

Similar findings from the 2003-2004 CDC data (the US birth certificate was revised in 2003 to include the location and attendant at the birth): http://www.sciencebasedmedicine.org/index.php/the-tragic-death-toll-of-homebirth/

Neonatal mortality rate

CNM = Certified Nurse Midwife (hospital birth), DEM = Direct Entry Midwife (home birth)

Other related articles:

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    A personal anecdote: My wife and oldest child would both likely be dead if we hadn't been in a hospital, just down the hall from an operating room. We weren't previously aware of any risk factors. – BradC Oct 3 '12 at 22:35
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    One note, this shows that they are more likely to die between 8-28 days. This could be explained by the fact that many who choose home birth also do not take their children for well baby checkups. I think this explains the data better than assuming the increase death rate is caused by home birth. Remember that correlation does not equal causation. In this case, it well may be a common cause. – William Grobman Oct 4 '12 at 3:34
  • I didn't dig deep enough to see if any of the studies adjusted for those factors, @WilliamGrobman, I suppose it's possible. But I think the discrepancy is more likely to be due to actual medical problems experienced in home births where emergency care couldn't be administered quickly, resulting in a baby hanging on life support for a couple weeks. We'd probably have to drill into the details of the actual deaths to know for sure. – BradC Oct 4 '12 at 15:07
  • that would be really interesting to investigate. I could easily see both having a substantial affect on the neonatal mortality rate. I'm not sure which would be the larger contributor though. To estimate their relative magnitudes, it would be interesting to compare the fraction of neonatal hospital deaths with 7+ days of life support to the fraction of well baby checkup refusing home birthers and estimates of how effective at reducing mortality neonatal care is. – William Grobman Oct 4 '12 at 16:51
  • Read the full article at the first link, the author discusses the "why neonatal deaths and not perinatal deaths" question a bit. I looked, though, and didn't see any mention of the lack of well-baby follow-ups, so if that is any factor at all, that study doesn't appear to address it. – BradC Oct 4 '12 at 20:56
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The subject is matter of debate, at least in The Netherlands, where home-birthing is very common. A Dutch-language blog article links to a number of studies which different conclusions. In 2010, a study was published concluding that homebirthing is more risky:

  • Perinatal mortality and severe morbidity in low and high risk term pregnancies in the Netherlands: prospective cohort study, Annemieke C C Evers et al, BMJ 2010; 341:c5639 / doi: 10.1136/bmj.c5639

However, the study was criticised at a number of points. From

Given the limitations of the study, the conclusion that labour starting in primary care carries a higher risk of delivery related perinatal death compared to labour starting in secondary care is premature from a scientific point of view.

So, it's probably not at all easy to answer the question.

  • "where home-birthing is very common" - is or was? According to midwife I've spoken to, hospital birth is common nowadays. – vartec Oct 4 '12 at 10:04
  • How trust-worthy are rapid responses? – Andrew Grimm Oct 4 '12 at 13:48
  • @vartec Hospital births are growing in popularity but home-birthing is still common compared to many other developed countries. – gerrit Dec 14 '15 at 11:20

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