Is it safer to have a baby at home or in a hospital? Depends on your country.
A review article published several months ago came to a startling conclusion: For low-risk pregnant women, it is safer to have a baby at home than in a hospital. The data upon which the review was based came from Britain.
But earlier this month, a study in the U.S. was released, which had different findings: Although planned home births were associated with a lower rate of cesarean section than standard in-hospital births, babies born following planned home birth were slightly more likely to die (3.9 versus 1.8 deaths per 1,000 deliveries). Interestingly, babies born following home births were less likely to end up in a neonatal intensive care unit (NICU).
In other words, while there seem to be advantages to home birth in the U.S. (lower rates of NICU stays, higher rates of uncomplicated vaginal deliveries), unlike in the U.K., neonatal outcomes seem to be better overall in the hospital setting.
What explains these interesting and somewhat contradictory findings?
First, in Britain at least, the fancy tests, procedures, and other tools that clinicians use in the hospital setting may do almost as much harm as good. In the hospital, obstetricians are more likely to intervene with forceps and perform other interventions during delivery — which may lead to complications for the baby. Additionally, babies born in the hospital setting are exposed to infections that lead to complications. As a result, babies seem to do at least as well when born at home rather than in a hospital.
In the U.S., hospital deliveries are also fraught with these perils. Yet hospital deliveries appear safer than deliveries at home here.
Why? In Britain, when a complication occurs during a home delivery, there areeffective system to rapidly transfer women to the hospital in a timely manner for appropriate treatment. Specifically, there are protocols to quickly transfer women experiencing complications to the hospital using emergency medical services. In fact, almost half of British women attempting home births end up being transferred to the hospital — a testament to just how functional these systems are.
But in the U.S., such protocols are poorly developed, and relationships are rarely in place to enable rapid hospital transfers when a woman experiences a complication while giving birth. Not surprisingly, babies born following home birth attempts in the U.S. experience worse outcomes on average.
There are some important Slow Medicine takeaways from this new research. First, it appears that in the U.S. we ought to develop effective transfer systems that would allow for safer births outside of a traditional hospital setting. As an initial step, it would be sensible to investigate the use of free-standing birthing centers (frequently staffed with midwives) that have close ties to hospitals and may already have many of the systems in place to enable rapid hospital transfers when complications arise.
Just as importantly, these results should trigger a reassessment of how we care for women delivering babies in the hospital setting. Perhaps it is time for us to re-examine the invasive things we do to women during the birthing process. It appears that many of the interventions that clinicians perform — forceps deliveries, early C-sections, and other procedures — may not be necessary and can in fact be harmful.
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