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Midwifery

Lower risk of problems in midwife-assisted home births, study finds Add to ...

The heated debate over the safety of home births with a midwife deepened yesterday after new research suggested it can be just as safe as delivering in a hospital, and even lower the risk of certain complications among some low-risk women.

But Canada's national organization of obstetricians and gynecologists warned the results may be misleading because they take certain differences between hospital and home birth out of context and don't account for the fact women who deliver at home must meet certain health and safety criteria, meaning they could be less prone to complications than others.

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"I would say [home birth]is probably as safe [as hospital birth]" said André Lalonde, executive vice-president of the Society of Obstetricians and Gynaecologists of Canada, adding "I don't think they can draw that conclusion … that it's safer."

The study, published online yesterday in the Canadian Medical Association Journal, is one of the largest of its kind and may help boost the reputation of the small but growing number of midwives working across Canada, said lead author and associate professor in the school of population and public health, Patricia Janssen.





Melissa Boraski used a midwife for the birth of both her children. A growing number of Canadian women are choosing to deliver at home.











"The direction we're going in is maybe more women need to be aware of [home birth]as an option," Prof. Janssen said.

In the study, researchers looked at data from nearly 3,000 British Columbia women who planned a home delivery, about 4,750 who planned a hospital birth with a midwife, and about 5,330 women who had a hospital birth with a physician over a five-year period.









Women who planned to give birth at home but were transferred to a hospital because of complications were included in the study.

Nearly 80 per cent of women who planned to give birth at home actually did.

Researchers found the rate of perinatal death was similarly low - less than one in 1,000 - among the three groups studied.

They also found the need for electronic fetal monitoring, epidural analgesia, assisted delivery, cesarean delivery, infection and other problems or interventions was lower among those who planned a home birth.

About 6 per cent of women who planned a home birth received oxytocin, a hormone that can initiate or speed up labour, compared with nearly 13 per cent of women delivering in hospital with a midwife, and more than 18 per cent of women giving birth in hospital with a physician. Similarly, less than 4 per cent of the home birth group experienced a postpartum hemorrhage, compared with nearly 7 per cent in the hospital group attended by a physician.

Although they are still a minority, a growing handful of Canadian women have been choosing to give birth at home with a registered midwife in recent years. Many provincial governments have responded by funding midwifery services so there are no costs to patients.

The Canadian Association of Midwives said there are more than 700 practising midwives in Canada. Midwifery services are regulated everywhere except Prince Edward Island, Newfoundland and Labrador and Yukon, association president Gisela Becker said.

"In most communities midwives cannot take on all the clients who are asking for midwifery service," she said.

Ms. Becker said the new study provides encouraging results about the safety of giving birth the old-fashioned way at a time when the trend toward medicated deliveries and elective Cesarean sections continues to dominate.

"I think it really validates that people can choose safely a home birth," she said.

But does giving birth at home actually carry fewer risks than at a hospital? According to Dr. Lalonde, the answer is no.

Many factors can explain different outcomes between the two options, he said. For instance, researchers believe there is an inherent "self-selection" bias in which women who are very healthy and have few underlying risks are the ones who tend to opt for home delivery.

In addition, women choosing home birth may be less inclined than others to avoid medical interventions, such as assisted delivery.

The SOGC doesn't have an official position on the safety of home birth. Dr. Lalonde said the organization would like to see more research before making any recommendation, but added that it does consider home births to be as safe as hospital births for low-risk women - but not safer.

Follow on Twitter: @carlyweeks

 

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