Risk triples for babies if first-time mothers choose home birth

First-time mothers who choose to give birth at home are almost three times more likely to have a baby who suffers a bad outcome including death or brain damage, new research shows.

A study of almost 65,000 births found that babies born to women giving birth for the first time were 2.8 times more likely to suffer serious problems if they had a home birth compared to those born in hospital obstetric units.

Problems include stillbirth after the start of labour, the baby dying within the first week of birth, brain injury, fractures to the upper arm or shoulder during birth, and faeces in the lung, which can require intense medical attention.

But the researchers, writing in the British Medical Journal, said overall their findings showed that the number of serious complications was low, and women should be given a choice of where to give birth.

Serious adverse outcomes for the baby are rare, the study found, occurring just 3.5 times for every 1,000 babies whose births were planned in an obstetric unit.

But this figure rises to 9.5 per 1,000 babies if the first-time mother chooses a home birth. These figures relate to women who have had a low-risk pregnancy and who did not have any complications at the start of labour. The researchers, from Oxford University, found there was no increased risk for babies whose birth was planned at units led by midwives.

There was also no increased risk for second or subsequent babies whose mothers planned a home birth – the finding only applied to first-time mothers.

The researchers stressed that giving birth was generally very safe. For all the women studied, the risk of harm to the baby was 4.3 per 1,000 births.

But the researchers did find women had a higher chance of an intervention – such as Caesarean, ventouse or forceps delivery, or epidural – if they chose to give birth in an obstetric unit.

Professor Peter Brocklehurst, who led the study, said adverse events were very uncommon. “For every 1,000 women, 995 babies would have a completely normal outcome,” he said.

While the study was based on births in England, Prof Brocklehurst said the results would be applicable across the UK, including Scotland.

“Obviously, Scotland and Wales have issues in terms of how far some women live away from hospitals,” he said.

He said that how remoteness affects birth outcomes was not clear, as women giving birth in midwifery units would also have to travel to obstetric units if they suffered complications – but they did not show an increase in adverse incidents.

“We don’t know why we have seen this excess but we can only begin to speculate. It may be that the transport mechanisms are better from midwifery units than they are from home, or anecdotally some people have suggested they are worse. So it is difficult to know what the problem is.”

Gillian Smith, Scottish director of the Royal College of Midwives, said they would look at the research and how it would apply in Scotland. But she expressed concern that it could be used by those wishing to push women away from home births.

“The number [of adverse incidents] is very low and it is important that we remember that,” she said.

A Scottish Government spokeswoman said: “The choice of where and how to give birth should be reached using a process of decision making where the clinician and the woman are partners in ensuring the woman and baby are as safe as possible.”