The largest study yet on the safety of home
births suggests that, in most cases, the risk to babies is
no higher than if they are born in a hospital.
Research from the Netherlands - which has a high rate of
home births - found no difference in death rates of either
mothers or babies in 530,000 births.
However, only women who were deemed to be at low risk of
complications were included in the Dutch study.
UK obstetricians welcomed the study but said it may not
Home births have long been debated amid concerns about
But the number of mothers giving birth at home has been
rising since it dipped to a low in 1988. Of all births in
England and Wales in 2006, 2.7% took place at home, the most
recent figures from the Office for National Statistics showed.
The research - published in the BJOG - was carried out
in the Netherlands after figures showed the country had one
of the highest rates in Europe of babies dying during or just
It was suggested that home births could be a factor, as
Dutch women are able and encouraged to choose this option.
But a comparison of "low-risk" women who planned
to give birth at home with those who planned to give birth
in hospital with a midwife found no difference in death or
serious illness among either baby or mother.
"We found that for low-risk mothers at the start of
their labour it is just as safe to deliver at home with a
midwife as it is in hospital with a midwife," said Professor
Simone Buitendijk of the TNO Institute for Applied Scientific
"These results should strengthen policies that encourage
low-risk women at the onset of labour to choose their own
place of birth."
Low-risk women in the study were those who had no known
complications - such as a baby in breech or one with a congenital
abnormality, or a previous caesarean section.
Nearly a third of women who planned and started their labours
at home ended up being transferred as complications arose
- including for instance an abnormal fetal heart rate, or
if the mother required more effective pain relief in the form
of an epidural.
But even when she needed to be transferred to the care
of a doctor in a hospital, the risk to her or her baby was
no higher than if she had started out her labour under the
care of a midwife in hospital.
The researchers noted the importance of both highly-trained
midwives who knew when to refer a home birth to hospital as
well as rapid transportation.
While stressing the study was the most comprehensive yet
into the safety of home births, they also acknowledged some
The group who chose to give birth in hospital rather than
at home were more likely to be first-time mothers or of an
ethnic minority background - the risk of complications is
higher in both these groups.
The study did not compare the relative safety of home births
against low-risk women who opted for doctor rather than midwife-led
care. This is to be the subject of a future investigation.
But Professor Buitendijk said the study did have relevance
for other countries like the UK with a highly developed health
infrastructure and well-trained midwives.
In the UK, the government has pledged to give all women
the option of a home birth by the end of this year. At present
just 2.7% of births in England and Wales take place at home,
but there are considerable regional variations.
Louise Silverton, deputy general secretary of the Royal
College of Midwives, said, the study was "a major step
forward in showing that home is as safe as hospital, for low
risk women giving birth when support services are in place.
"However, to begin providing more home births there
has to be a seismic shift in the way maternity services are
organised. The NHS is simply not set up to meet the potential
demand for home births, because we are still in a culture
where the vast majority of births are in hospital.
"There also has to be a major increase in the number
of midwives because they are the people who will be in the
homes delivering the babies."
The Royal College of Obstetricians and Gynaecologists (RCOG)
said it supported home births "in cases of low-risk pregnancies
provided the appropriate infrastructures and resources are
present to support such a system.
But it added: "Women need to be counselled on the
unexpected emergencies - such as cord prolapse, fetal heart
rate abnormalities, undiagnosed breech, prolonged labour and
postpartum haemorrhage - which can arise during labour and
can only be managed in a maternity hospital.
"Such emergencies would always require the transfer
of women by ambulance to the hospital as extra medical support
is only present in hospital settings and would not be available
to them when they deliver at home."
The Department of Health said that giving more mothers-to-be
the opportunity to choose to give birth at home was one of
its priority targets for 2009/10.
A spokesman said: "All Strategic Health Authorities
(SHAs) have set out plans for implementing Maternity Matters
to provide high-quality, safe maternity care for women and