While the number of women in developed countries who plan a home birth is low, the number has increased over the past decade in the US, and there is evidence that more women would choose this option if it were readily available. Rates of planned home birth range from 0.1% in Sweden to 20% in the Netherlands, where home birth has always been an integrated part of the maternity system. Benefits of planned home birth include lower rates of maternal morbidity, such as postpartum hemorrhage, and perineal lacerations, and lower rates of interventions such as episiotomy, instrumental vaginal birth, and cesarean birth. Women who have a planned home birth have high rates of satisfaction related to home being a more comfortable environment and feeling more in control of the experience. While maternal outcomes related to planned birth at home have been consistently positive within the literature, reported neonatal outcomes during planned home birth are more variable. While the majority of investigations of planned home birth compared with hospital birth have found no difference in intrapartum fetal deaths, neonatal deaths, low Apgar scores, or admission to the neonatal intensive care unit, there have been reports in the US, as well as a meta-analysis, that indicated more adverse neonatal outcomes associated with home birth. There are multiple challenges associated with research designs focused on planned home birth, in part because conducting randomized controlled trials is not feasible. This report will review current research studies published between 2004 and 2014 related to maternal and neonatal outcomes of planned home birth, and discuss strengths, limitations, and opportunities regarding planned home birth.

For most participants, dissatisfaction with hospital birth influenced their subsequent decision to choose home birth. Despite experiencing challenges associated with this decision, women expressed satisfaction with their home birth.

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Background Existing clinical measurements of pelvic floor muscle strength are contaminated by crosstalk from intra-abdominal pressure. We tested an improved instrumented speculum designed to minimize this crosstalk. The hypotheses were that the speculum yields: 1) maximum vaginal closure forces unrelated to intra-abdominal pressure, 2) discriminatory validity between women who have strong vs. weak pelvic floor muscles, and 3) acceptable test-retest reliability. Methods Maximum voluntary vaginal closure force was measured in 40 incontinent women (20–77 years) using the improved instrumented speculum on two visits spaced one month apart. At the baseline visit, intra-abdominal pressure was also estimated via intra-vesical catheterization during the vaginal closure force measurement. Subjective estimate of pelvic floor muscle strength was also assessed using digital palpation by a skilled examiner to determine group placement as “strong” (n=31) or “weak” (n=9). Findings Vaginal closure force was not significantly correlated with intra-abdominal pressure (r = −.26, p = .109). The groups with subjectively scored strong and weak pelvic floor muscles differed significantly by mean [SD] maximum vaginal closure force (3.8 [1.7] vs. 1.9 [0.8] N respectively, p < .01.) Across both time points the mean vaginal closure force was 3.42 [1.67] N with a range of .68 to 9.05 N. Mean Visit 1 and Visit 2 vaginal closure force scores did not differ (3.41 [1.8] and 3.42 [1.6] N, respectively). The vaginal closure force repeatability coefficient was 3.1 N. Interpretation The improved speculum measured maximum vaginal closure force without evidence of crosstalk from intra-abdominal pressure, while retaining acceptable discriminant validity and repeatability.

Objective To describe occurrence, recovery, and consequences of musculoskeletal injuries in women at-risk for childbirth-related pelvic floor injury at first vaginal birth. Study Design Evaluating Maternal Recovery from Labor and Delivery (EMRLD) is a longitudinal cohort design study of women recruited early post-birth and followed over time. We report here on 68 women who had birth-related risk factors for levator ani muscle injury, including long second stage, anal tears, and/or older maternal age, and who were evaluated by musculoskeletal magnetic resonance imaging at both 7-weeks and 8-months postpartum. We categorized magnitude of injury by extent of bone marrow edema, pubic bone fracture, levator ani muscle edema, and levator ani muscle tear. We also measured the force of levator ani muscle contraction, urethral pressure, pelvic organ prolapse, and incontinence. Results In this higher-risk sample, 66% (39/59) had pubic bone marrow edema, 29% (17/59) had subcortical fracture, 90% (53/59) levator ani muscle edema, and 41% (28/68) low-grade or greater levator ani tear 7-weeks postpartum. The magnitude of levator ani muscle tear did not substantially change by 8-months postpartum (p=0.86), but levator ani muscle edema and bone injuries showed total or near total resolution (p<.05). The magnitude of unresolved musculoskeletal injuries correlated with magnitude of reduced levator ani muscle strength and posterior vaginal wall descent (p<.05) but not with urethral pressure, volume of demonstrable stress incontinence, nor self-report of incontinence severity (p>.05). Conclusion Pubic bone edema and subcortical fracture and levator ani muscle injury are common when studied in women with certain risk factors. The bony abnormalities resolve, but levator tear does not, and is associated with levator weakness and posterior-vaginal wall descent.