Planned Home Births in the United States Have Outcomes Comparable to Planned Birth Center Births for Low-Risk Birthing Individuals
This study, using data from two large national registries, found that planned home births for low-risk pregnancies are just as safe as planned birth center births. Outcomes, including transfer rates, maternal and neonatal hospitalization, hemorrhage, NICU admission, and perinatal death, were comparable between the two birth settings. These findings challenge the American College of Obstetricians and Gynecologists' (ACOG) recommendation against planned home births and suggest that both home and birth center births offer similar levels of safety for low-risk pregnancies.
College of Health researcher(s)
Abstract
Objective
There are lingering concerns in the United States about home birth. We used 2 large (n = 50,043; n = 62,984), national community birth registries to compare maternal and neonatal outcomes for planned home versus planned birth center births.
Methods
To compare outcomes by intended birth site, we used logistic regressions, controlling for demographic and pregnancy risk variables. Maternal outcomes included intrapartum or postpartum transfer to hospital, hospitalization, cesarean, and hemorrhage; neonatal outcomes included neonatal transfer, hospitalization, neonatal intensive care unit admission, and intrapartum or neonatal death. Analyses were conducted twice, once in each dataset.
Results
Individuals who planned home births had a lower incidence of all types of transfers, compared with those who planned birth center births, but in one dataset only, experienced more cesareans [adjusted odds ratio (95% CI): 1.32 (1.02–1.70); 0.95 (0.88–1.03)]. Planned home birth was associated with lower adjusted odds of maternal hospitalization in one dataset but not the other [0.97 (0.54–1.74); 0.85 (0.76–0.95)], and was not associated with hemorrhage. Neonatal outcomes likewise were either not associated with a planned birthplace or suggested home birth was safer: hospitalization [0.77 (0.53–1.11), 0.90 (0.82–0.98)], neonatal intensive care unit admission [0.54 (0.28–1.00), 0.97 (0.86–1.10)]. There was no observable association with intrapartum or neonatal death: 1.07 (0.68–1.67; only calculated once because of small numbers of events).
Conclusions
Planned home births are as safe as planned birth center births for low-risk pregnancies. Current guidelines advising against planned home births are not supported by these data.
Research Study FAQ
What is the main finding of the study?
The study found that planned home births are as safe as planned birth center births for low-risk pregnancies, based on a comparison of numerous maternal and neonatal outcomes including transfer rates, cesarean section rates, hemorrhage, NICU admissions, and perinatal death.
What data sources were used in the study?
The study utilized two large national community birth registries: the Midwives Alliance of North America Statistics (MANAStats) and the American Association of Birth Centers' Perinatal Data Registry (PDR). These registries contain extensive data on prenatal, birth, and postpartum care processes and outcomes for midwife-attended, planned community births in the United States.
Why did the researchers choose to analyze the two datasets separately?
The researchers initially planned to merge the datasets but opted for separate analyses due to the uneven distribution of planned birth locations between the two registries (MANAStats predominantly consisting of home births and PDR mostly comprising birth center births), differences in outcome variable definitions, and potential overlap of records from midwives contributing to both registries. Analyzing the datasets separately enhanced the internal validity of the findings.
What were the key differences in the characteristics of individuals planning home births versus birth center births?
The study found some differences between the two groups. Individuals planning home births in the MANAStats dataset were more likely to have a Bachelor's degree or higher education compared to those planning birth center births. Conversely, the PDR dataset showed a higher proportion of individuals with a Bachelor's degree or higher among those planning birth center births. The PDR sample also had greater racial diversity. Notably, Certified Nurse Midwives (CNMs) were the primary providers in the PDR data, while Certified Professional Midwives (CPMs) predominantly contributed to the MANAStats data.
How did transfer rates compare between planned home births and planned birth center births?
The study found a consistent trend across both datasets: individuals planning home births had lower rates of intrapartum, postpartum, and neonatal transfers compared to those planning birth center births. This difference was more pronounced in the PDR data, where planned home births showed approximately a 40% reduction in the odds of transfers. The MANAStats data indicated a more modest reduction of around 15%.
Were there any differences in perinatal mortality rates between the two groups?
No, the study found no significant difference in perinatal mortality rates between planned home births and planned birth center births. This finding contradicts a common critique of home births, suggesting that both planned home and birth center births offer similar levels of safety in low-risk pregnancies.
What is the significance of the findings in relation to the American College of Obstetricians and Gynecologists (ACOG) guidelines?
The study's findings challenge the ACOG's current position that birth in an accredited birth center is preferable to home birth for low-risk pregnancies. The evidence presented supports the safety and comparable outcomes of both planned home and birth center births, suggesting that ACOG should revise its guidelines to reflect these findings.
What are the study's implications for future research and practice?
The study highlights the need to revise existing guidelines and improve the integration and transfer processes between community birth settings and hospitals. Future research should focus on understanding the factors contributing to differences in transfer rates and cesarean section rates between home births and birth center births. Healthcare professionals need to collaborate to ensure equitable access to various birth settings and improve the experience of transfers for community birth patients when complications arise.