METAANALYSIS OF THE SAFETY OF HOME BIRTH

Background: The safety of planned home birth is controversial. This st udy examined the safety of planned home birth backed up by a modern ho spital system compared with planned hospital birth in the Western worl d. Methods: A meta-analysis of six controlled observational studies wa s conducted, and the perinatal outcomes of 24,092 selected and primari ly low-risk pregnant women were analyzed to measure mortality and morb idity, including Apgar scores, maternal lacerations, and intervention rates. Confounding was controlled through restriction, matching, or in the statistical analysis. Results: Perinatal mortality was not signif icantly different in the two groups (OR = 0.87, 95% CI 0.54-1.41). The principal difference in the outcome was a lower frequency of low Apga r scores (OR = 0.55; 0.41-0.74) and severe lacerations (OR = 0.67; 0.5 4-0.83) in the home birth group. Fewer medical interventions occurred in the home birth group, induction (statistically significant ORs in t he range 0.06-0.39), augmentation (0.26-0.69), episiotomy (0.02-0.39), operative vaginal birth (0.03-0.42), and cesarean section (0.05-0.31) . No maternal deaths occurred in the studies. Some differences may be partly due to bias. The findings regarding morbidity are supported by randomized clinical trials of elements of birth care relevant for home birth, however; and the finding relating to mortality is supported by large register studies comparing hospital settings of different level s of care. Conclusion: Home birth is an acceptable alternative to hosp ital confinement for selected pregnant women, and leads to reduced med ical interventions.