ScienceDaily (Sep. 19, 2012) — A new Cochrane Review concludes that all
countries should consider establishing proper home birth services. They should
also provide low-risk pregnant women with information enabling them to make an
informed choice. The review has been prepared by senior researcher, statistician
Ole Olsen, the Research Unit for General Practice, University of Copenhagen, and
midwifery lecturer PhD Jette Aaroe Clausen.

In many countries it is believed that the safest option for all women is to give
birth in hospital. However, observational studies of increasingly better quality
and in different settings suggest that planned home birth in many places can be
as safe as planned hospital birth and with less intervention and fewer

"If home birth is going be an attractive and safe option for most pregnant
women, it has to be an integrated part of the health care system," Ole Olsen
says and adds, "In several Danish regions the home birth service has been very
well organized for several years. This is not the case everywhere in the world."

The updated Cochrane Review concludes that there is no strong evidence from
experimental studies (randomized trials) to favor either planned hospital birth
or planned home birth for low-risk pregnant women. At least not as long as the
planned home birth is assisted by an experienced midwife with collaborative
medical back up in case transfer should be necessary.

Fewer interventions in home birth

Routines and easy access to medical interventions may increase the risk of
unnecessary interventions in birth explaining why women who give birth at home
have a higher likelihood for a spontaneous labour. There are 20-60 per cent
fewer interventions, for example fewer cesarean sections, epidurals and
augmentation among those women who plan a homebirth; and 10-30 per cent fewer
complications, for example post partum bleeding and severe perineal tears.

"Patience is important if women want to avoid interference and give birth
spontaneously," says Jette Aaroe Clausen. "At home the temptation to make
unnecessary interventions is reduced. The woman avoids for example routine
electronic monitoring that may easily lead to further interventions in birth."

Jette Aaroe Clausen adds that interventions in childbirth are common in many
countries, but also that there is a growing concern internationally because
interventions may lead to iatrogenic effects; iatrogenic effects meaning
unintended consequences of the intervention. Routine electronic monitoring may
for example lead to more women having artificial rupture of membranes which in
turn can lead to more interventions.

Evidence and human rights

While the scientific evidence from observational studies has been growing, the
European Court of Human Rights in Strasbourg in the case Ternovszky versus
Hungary has handed down a judgment stating that "the right to respect for
private life includes the right to choose the circumstances of birth." This is
quoted in the review.

Thus the conclusions of the review are based on human rights and ethics as well
as on results from the best available scientific studies.

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Journal Reference:

Ole Olsen, David Jewell. Home versus hospital birth. The Cochrane Library,
12 SEP 2012 DOI: 10.1002/14651858.CD000352

University of Copenhagen (2012, September 19). Birth is no reason to go to
hospital, review suggests. ScienceDaily. Retrieved September 20, 2012, from:­ /releases/2012/09/120919083454.htm