It is no more hazardous for women with low-risk pregnancies to give birth at home than at the hospital, according to a mega-study published in the Lancet by Canadian researchers. Morbidity and mortality rates of the newborns, and their Apgar results, are the same in both cases, the researchers report.
Their work was based on 14 different studies beginning in 1990 and covering about half-a-million home births and another half-million hospital births in Sweden, New Zealand, the United Kingdom, the Netherlands, Japan, Australia, Canada and the United States. The proportion of newborns winding up in intensive care was also the same after the two types of births, the article reports.
As to deaths right after birth or within the first four weeks of life, the researchers found no statistical or clinical differences. Again, it should be remembered that the entire study, led by McMaster University and published on the Lancet site EClinicalMedicine, relates to women at low risk.
“More women in well-resourced countries are choosing birth at home, but concerns have persisted about their safety,” said Eileen Hutton, professor emeritus of obstetrics and gynecology at McMaster, founding director of the McMaster Midwifery Research Centre and the lead author of the paper. “This research clearly demonstrates the risk is no different when the birth is intended to be at home or in hospital.”
There was also no difference in the morbidity and mortality rates of the women themselves, say the authors, who also note that all the studies upon which they based their meta-analyses underwent peer review.
In Israel the medical establishment encourages hospital birth. Presently, only about 800 of every 180,000 births in the country are planned to take place at home. In 2012 the Health Ministry published a circular stating that it respects every woman’s freedom of choice as to where to give birth, but as the authority responsible for public health, it sees a need – as part of its professional and ethical duty – to stress that recognized, approved birthing rooms are safer for the mother and the child.
The pamphlet also spells out the required conditions under which a doctor or midwife can consent to assist at a home birth, which include: a single fetus with a head presentation (i.e., facing the mother’s pelvis); an estimated birth weight ranging from 2.5 to 4 kilos; a documented medical history of the mother, including all necessary pre-natal screenings and scans; no gestational diabetes, and so on. The mother must also be able to reach a hospital within half an hour.
The mega-study was based on data from a large number of women, although it did not include Israel, but its results must be carefully interpreted, says Prof. Arnon Wiznitzer, director of the Helen Schneider Hospital for Women at Beilinson Hospital. Moreover, most of the countries included in the new research offer on-call support systems for home births, among them special obstetric teams, which do not exist in Israel; some births that have taken place at home here have not gone well, he adds.
Despite the results of the new study, Wiznitzer supports the medical establishment’s policy, adding that it’s only possible to definitively call a birth low-risk after it has taken place, not before.
One option the professor suggests is for hospitals to create special facilities for natural births with a homey feeling, on their premises – where soon-to-be parents will know there’s expert help right next door.
Michal Bonstein, midwife and chairwoman of the midwives association in Israel, applauded the meta-study and says that it proves that a home birth which is managed professionally is not risky and is a good option for mother and child. In view of the new data, she asks why the Health Ministry and National Insurance Institute discriminate against home birthers and the midwives who assist them – in terms of creating problems related to insurance, registration of the newborn and so on. The result, says Bonstein, is that some pregnant women end up seeking potentially dangerous, unprofessional solutions.
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