First-Time Home Birth Risky, Warns Study

For first-time mothers, giving birth at home is a risky choice.

First-born children are almost three times more likely to suffer serious problems at home than in hospital obstetric units, increasing the risks of their dying or suffering brain damage, new research has warned.

The landmark study, published in the British Medical Journal, has also found that first-time mothers are 2.8 times more likely to suffer serious problems at home than in hospital obstetric units. Traditional maternity units in hospitals remain the safest place for women to have their first child.

Due to complications during labor, nearly half of the women, 45 percent, who wanted to give birth at home had to be moved to hospital in comparison to less than 12 percent who had previously given birth. With labor not progressing properly or the need of an epidural during home birth, there were higher risks of the first-born child's death from injuries on the upper arms or shoulders.

Professor Peter Brocklehurst, who led The Birthplace in England study at Oxford University but has since moved to University College London, said he believes that women should have a choice over where they have their babies.

"The risks of an adverse outcome for a baby are higher for a woman planning her first baby at home than in all of the other settings, but there was no difference between the midwife and hospital obstetric units," a BBC report on the study quoted Prof Brocklehurst as saying.

"The risks could be to do with the sort of women who chose home birth, who tended to be white, slightly older, better educated and live in more affluent areas, the midwife's experience, problems in transferring to hospital in an emergency or something else entirely. More work would be needed to establish what was happening," he said.

The study also mentioned the difficult outcomes for newborns - including stillbirth, death soon after birth and oxygen deprivation, trauma at birth, or the baby becoming distressed - were much rarer in women who had low-risk pregnancies. Generally, the risk rate in 4.3 per 1,000 births for women having low-risk pregnancies was not much different from a hospital delivery or elsewhere. But the risk for first-time mothers giving birth at home was much higher (9.3 per 1,000 births) in comparison to babies born in hospitals (5.3) or a dedicated birth centre (4.5).

While comparing the complications and risks before the start of labor between home births and hospital births, the study said that hospital outcomes were better: 9.5 per 1,000 at home compared with 3.5 in hospital, an increase of nearly three percent.

"This study has shown that first-time mothers wishing to deliver at home place their babies at an increased risk, thus raising questions about the right birth location for this group of women," Dr Tony Falconer, president of the Royal College of Obstetricians and Gynaecologists, has been quoted by the Daily Mail as saying. "In addition, having to transfer 36 percent of mothers from a free-standing midwifery unit to obstetric units raises many issues," he added.

The Birthplace in England study, which compared data on 65,000 women, considered the low risk of complications for mothers who planned to give birth either in a hospital maternity department, at home or in a midwife-led birthing unit.

With a limited delivery choice offered to women in England, only three percent give birth at home and about 90 percent of babies are born in hospital obstetric units, according to the study.

It said that mothers who planned to give birth at home or in a birth centre and, at least, started their care there were far less likely to have interventions, such as caesarean sections, epidurals for pain relief and forceps deliveries.

However, women who chose to give birth in a consultant-led hospital maternity unit had a higher chance of an intervention. The report suggests that only 58 percent of these women had a natural birth without any intervention, compared with 88 percent of women giving birth at home and three-quarters of women in a midwife-led unit.

More than 11 percent of women whose care began in hospital had a caesarean, compared with 2.8 percent of those who began at home. In hospital, 6.8 percent of deliveries were by forceps, compared with 2.1 percent at home, The Guardian reported.