The first I read is from England, and it compared midwife-attended home births, midwife-attended center births, midwife-attended hospital births & doctor-attended hospital births. The findings were fascinating: for first-time births, midwife-attended center births are safest overall; fewer C-sections & other interventions risky to the mom, as well as low infant mortality & morbidity. Midwife-attended hospital births were next, followed by doctor-attended hospital births. Home births were marginally less safe (we're talking under 1% difference). For all later births, there was no difference in harm to the baby. However, as far as "normal" birth is concerned (meaning one without interventions like forceps, and episiotomies), home birth is the clear winner. Here's how the percentages stack up for normal births: 90% home birth, 83% freestanding midwife unit, 76% hospital midwife unit, and 60% hospital obstetric unit.
This Oxford University research raises fundamental questions about maternity care in the UK. Nine out of 10 babies are born in medically-led obstetric units. There has been a trend to centralise this into fewer and larger centres to guarantee consultant cover. Many of the decisions have taken place without definitive evidence about the safety for babies and the experience for mothers. This study provides that.
It reveals an unexplained difference in the rate of normal birth between units run by midwives and those run by doctors. The disparity on emergency Caesarean sections is particularly striking. It suggests a different culture in the way midwives and doctors see birth, with doctors concerned about risks and midwives focused on normality.
The second article is on a similar study in Canada, though from 2000-2004 (published in 2009). It compared midwife-attended home births, midwife-attended hospital births and doctor-attended hospital births, and revealed "the mortality rate per 1,000 births was 0.35 in the home birth group, 0.57 in hospital births attended by midwives, and 0.64 among those attended by physicians." This article continues:
Women who gave birth at home were less likely to need interventions or to have problems such as vaginal tearing or hemorrhaging. These babies were also less likely to need oxygen therapy or resuscitation, the study found.
The authors acknowledge that "self-selection" could have skewed the study results, in that women who prefer home deliveries tend to be healthier and otherwise more fit to have a home birth.
Good stuff to think about!
Just as a note, it's enlightening to read the same UK study reported with a different "spin." While it's clear from the actual study that the risk to the babies was all under 1% (4.5 per 1000 to 9.3 per 1000), this study spins the data to say: "First-time mothers who opt for a home birth are almost three times more likely to have a baby who dies or suffers brain damage"! Sounds much more scary when it's put that way, doesn't it!? This just highlights why it's important to look at actual data, not just the way a newspaper reports them! (Here's a link to the actual medical journal article from the UK study, and a link to the Canadian study.)