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Meta‐analysis of the Safety of Home Birth
Author(s) -
Olsen Ole
Publication year - 1997
Publication title -
birth
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.233
H-Index - 83
eISSN - 1523-536X
pISSN - 0730-7659
DOI - 10.1111/j.1523-536x.1997.00004.pp.x
Subject(s) - medicine , episiotomy , observational study , obstetrics , randomized controlled trial , home birth , apgar score , psychological intervention , confounding , relative risk , low birth weight , pregnancy , childbirth , birth weight , pediatrics , confidence interval , surgery , nursing , genetics , pathology , biology
Background : The safety of planned home birth is controversial. This study examined the safety of planned home birth backed up by a modern hospital system compared with planned hospital birth in the Western world. Methods : A meta‐analysis of six controlled observational studies was conducted, and the perinatal outcomes of 24,092 selected and primarily low‐risk pregnant women were analyzed to measure mortality and morbidity, including Apgar scores, maternal lacerations, and intervention rates. Confounding was controlled through restriction, matching, or in the statistical analysis. Results : Perinatal mortality was not significantly 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 Apgar scores (OR = 0.55; 0.41–0.74) and severe lacerations (OR = 0.61; 0.54–0.83) in the home birth group. Fewer medical interventions occurred in the home birth group: induction (statistically significant ORs in the 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 levels of care. Conclusion : Home birth is an acceptable alternative to hospital confinement for selected pregnant women, and leads to reduced medical interventions.