Planned home birth: benefits, risks, and opportunities

Abstract

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.

Factors associated with women's desire for control of healthcare during childbirth: Psychometric analysis and construct validation

“…Contrary to our expectations, women with self‐reported medical conditions or complications of pregnancy and women without complications reported similar levels of desire for control as assessed using the DCCh. We also found support for our hypotheses that women who reported higher desire for control on the DCCh would be more likely to choose “non‐standard” childbirth attendants, such as midwives and doulas, consistent with a midwifery model of childbirth typically associated with giving birthing women more control over the birth environment (Cook & Loomis, ; Wood et al, ; Zielinski et al, ). The desire for control was also a predictor of choosing birth at home or a birth center rather than at a hospital.…”

Effect of planned place of birth on obstetric interventions and maternal outcomes among low-risk women: a cohort study in the Netherlands

“…Larger studies are needed into the relationship between planned place of birth and obstetric interventions in the Netherlands. In some other Western countries the rate of home births is increasing [20–22]. The findings of this study can be important for these countries, because we can provide a large enough dataset to show potential differences in outcomes between planned home and planned hospital births among low-risk women in the Netherlands.…”

Is fear of childbirth related to the woman’s preferred location for giving birth? A Dutch low‐risk cohort study

“…In contrast, in The Netherlands approximately half of all pregnant women, being low‐risk, are given the option of choosing either home birth or a hospital birth under the care of a midwife . Although, of all births, the percentage of home births declined in the past decade from nearly 30% to approximately 13%, this rate is still relatively high compared with other Western countries, in which only 0.5%‐2.2% of births occur at home …”