Maternal outcomes and birth interventions among women who begin labour intending to give birth at home compared to women of low obstetrical risk who intend to give birth in hospital: A systematic review and meta-analyses

Abstract

Background: We previously concluded that risk of stillbirth, neonatal mortality or morbidity is not different whether birth is intended at home or hospital. Here, we compare the occurrence of birth interventions and maternal outcomes among low-risk women who begin labour intending to birth at home compared to women intending to birth in hospital. Methods: We used our registered protocol (PROSPERO, http://www.crd.york.ac.uk, No.CRD42013004046) and searched five databases from 1990À2018. Using R, we obtained pooled estimates of effect (accounting for study design, study setting and parity). Findings: 16 studies provided data from ~500,000 intended home births for the meta-analyses. There were no reported maternal deaths. When controlling for parity in well-integrated settings we found women intending to give birth at home compared to hospital were less likely to experience: caesarean section OR 0.58 (0.44,0.77); operative vaginal birth OR 0.42(0.23,0.76); epidural analgesia OR 0.30(0.24,0.38); episiotomy OR 0.45(0.28,0.73); 3rd or 4th degree tear OR 0.57(0.43,0.75); oxytocin augmentation OR 0.37(0.26,0.51) and maternal infection OR 0.23(0.15,0.35). Pooled results for postpartum haemorrhage showed women intending home births were either less likely or did not differ from those intending hospital birth [OR 0.66(0.54,0.80) and RR 1.30(0.79,2.13) from 2 studies that could not be pooled with the others]. Similar results were found when data were stratified by parity and by degree of integration into health systems. Interpretation: Among low-risk women, those intending to birth at home experienced fewer birth interventions and untoward maternal outcomes. These findings along with earlier work reporting neonatal outcomes inform families, health care providers and policy makers around the safety of intended home births.

Global stakeholder perspectives of home birth: a systematic scoping review.

“…Here, women are supported to make informed choices about their maternity care, including where to give birth (4,5,9,12,13). For women at low risk of complications, this integration of health system support for home birth in high-resource countries has been associated with maternal and newborn outcomes similar to those of women experiencing hospital delivery (14,15). However, in low-and middle-resource countries (LMRCs), birth at home occurs much more frequently and may be associated with high mortality, although the number of facility-based births is increasing (16,17).…”

“…Searches were updated from our previous systematic review of home birth (14,15) and supplemented using a range of medical and social databases, including EMBASE, MEDLINE, CINAHL, AMED, ASSIA, ProQuest Thesis Dissertations and Cochrane Library. In addition, key websites (e.g.…”

Women’s experiences of planning a home birth with maternity care providers in middle to high-income countries: a systematic review protocol

“…These include amniotomy, augmentation of labour, instrumental vaginal birth, Caesarean Section, and opiate or regional analgesia [5][6][7]4 . There is also evidence that the outcomes for both multiparous and nulliparous women and babies of multiparous women who have birthed at home are equal to, if not better than those in other birth settings, for example women are less likely to experience 3rd or 4th degree perineal trauma, maternal infection or postpartum haemorrhage [4][5][8][9] . The Birthplace study also reported an increased incidence of adverse outcomes for the baby of nulliparous women who had a planned home birth 4 .…”

“…4). In their systematic review and meta-analysis, Rietsma et al 5 identi ed that women who plan to birth at home may hold different values around birth outcomes. However, they also recognised that those who plan a home birth are less likely to experience unnecessary interventions and adverse birth outcomes.…”

Lack of autonomy in facility-based births makes women become absentees of maternity services in Somaliland fragile contexts - a qualitative study

“…Home-based birth is common around the world [8][9][10][11][12]. In low-and middle-income countries the homebirth rate is often more than 50 percent whilst in high income countries the homebirth rate is no more than 1-3 percent.…”