Home Birth
| Rationale for Compliance |
Evidence Grade |
|
|---|---|---|
| Compared with a similar population of women having hospital births, planned home births with a qualified attendant resulted in the following maternal outcomes (including mothers who intended to give birth at home at the onset of labor but were transferred to the hospital at some time during or after labor): | ||
| similar rates of antepartum and/or intrapartum hypertension (PIH, pre-eclampsia) (Ackermann-Liebrich, 1996; Wiegers, 1996). | Quality: | A |
| Quantity: | B | |
| Consistency: | A | |
| fewer or similar rates of induction of labor (Janssen, 2002; Johnson, 2005; Olsen, 1997; Weigers, 1996). | Quality: | A |
| Quantity: | A | |
| Consistency: | A | |
| • fewer or similar rates of augmentation of labor (Janssen, 2002; Johnson, 2005; Olsen, 1997; Weigers, 1996). | Quality: | A |
| Quantity: | A | |
| Consistency: | A | |
| • lower incidence of active phase arrest of labor in multiparous women (cessation of progress in cervical dilation after 3–4 cm in women with prior births) (Wiegers, 1996). | Quality: | A |
| Quantity: | C | |
| Consistency: | NA* | |
| • less use of intravenous fluids in labor (see also Step 6, p. 34S) (Johnson, 2005). | Quality: | B |
| Quantity: | A | |
| Consistency: | NA* | |
| • less use of amniotomy in labor (see also Step 6, p. 38S) (Janssen, 2002; Johnson, 2005). | Quality: | A |
| Quantity: | A | |
| Consistency: | A | |
| • similar incidence of abnormal fetal heart rate in labor (Wiegers, 1996; Woodcock, 1994). | Quality: | B |
| Quantity: | B | |
| Consistency: | A | |
| • less use of continuous electronic fetal monitoring (external and internal) (Janssen, 2002; Johnson, 2005). | Quality: | A |
| Quantity: | A | |
| Consistency: | A | |
| • increased choice of movement and birth position in labor (see also Step 4, pp. 24S–26S) (Ackermann-Liebrich, 1996). | Quality: | A |
| Quantity: | B | |
| Consistency: | NA* | |
| • less need for analgesia in labor (Ackermann-Liebrich, 1996; Janssen, 2002). | Quality: | A |
| Quantity: | A | |
| Consistency: | A | |
| • less need for epidural and/or spinal anesthesia in labor (Janssen, 2002; Johnson, 2005). | Quality: | A |
| Quantity: | A | |
| Consistency: | A | |
| • fewer vaginal instrumental deliveries (vacuum extraction and forceps) (Janssen, 2002; Johnson, 2005; Olsen, 1997). | Quality: | A |
| Quantity: | A | |
| Consistency: | A | |
| • fewer cesarean sections as follows: | ||
| ○ fewer or equivalent cesareans (Janssen, 2002; Johnson, 2005; Olsen, 1997; Wiegers, 1996). | Quality: | A |
| Quantity: | A | |
| Consistency: | A | |
| ○ fewer cesareans in nulliparous women (Janssen, 2002). | Quality: | A |
| Quantity: | B | |
| Consistency: | NA* | |
| ○ fewer cesareans in multiparous women (Janssen, 2002). | Quality: | A |
| Quantity: | A | |
| Consistency: | NA* | |
| ○ fewer cesareans in women who have had a cesarean before (more vaginal births after cesarean) (Janssen, 2002). | Quality: | A |
| Quantity: | B | |
| Consistency: | NA* | |
| ○ fewer cesareans for labor progress disorders (labor dystocia, failure to progress, cephalopelvic disproportion, arrest of labor) (Janssen, 2002). | Quality: | A |
| Quantity: | B | |
| Consistency: | NA* | |
| ○ fewer or equivalent cesareans for emergencies in labor, such as fetal distress (Janssen, 2002; Woodcock, 1994). | Quality: | B |
| Quantity: | B | |
| Consistency: | A | |
| • fewer perineal injuries as measured by: | ||
| ○ more intact perineums (Ackermann-Liebrich, 1996; Janssen, 2002). | Quality: | B |
| Quantity: | A | |
| Consistency: | A | |
| ○ fewer episiotomies (Janssen, 2002; Johnson, 2005; Olsen, 1997; Wiegers 1996). | Quality: | A |
| Quantity: | A | |
| Consistency: | A | |
| ○ fewer or similar rates of anal sphincter laceration (Olsen, 1997; Wiegers, 1996). | Quality: | A |
| Quantity: | A | |
| Consistency: | A | |
| • reduced need for maternal blood transfusion (Wiegers, 1996). | Quality: | B |
| Quantity: | B | |
| Consistency: | NA* | |
| • less or equivalent incidence of maternal infection or need for antibiotics after birth (Janssen, 2002; Wiegers, 1996). | Quality: | A |
| Quantity: | A | |
| Consistency: | A | |
| Among women having a home birth after a hospital birth, 85% said they preferred the home birth experience and, of those planning more children, 91% said they would plan a home birth (Davies, 1996). | Quality: | B |
| Quantity: | B | |
| Consistency: | NA* | |
| Compared with similar women having hospital births, planned home births with a qualified attendant resulted in the following perinatal outcomes: | ||
| • similar percentages of low-birth-weight infants (Ackermann-Liebrich, 1996; Janssen, 2002; Wiegers, 1996). | Quality: | A |
| Quantity: | B | |
| Consistency: | B | |
| • similar rates of infants admitted to intensive care units (Wiegers, 1996). | Quality: | A |
| Quantity: | B | |
| Consistency: | NA* | |
| • less or similar rate of birth traumas (Durand, 1992; Wiegers, 1996; Woodcock 1994). | Quality: | A |
| Quantity: | A | |
| Consistency: | A | |
| • similar perinatal mortality rates for infants born to low-risk mothers planning homebirths (Gulbransen, 1997; Janssen, 2002; Olsen 1997). | Quality: | A |
| Quantity: | A | |
| Consistency: | A | |
| • increased incidence of neonatal acidemia in home-born infants compared with hospital-born infants. (Ackermann-Liebrich, 1996). However, evaluation by neutral pediatricians between day 2 and day 6 of life showed no differences between home- and hospital-born infants. Study authors explained that lower blood pH measurements are probably an artifact arising from the common practice of delayed cord clamping at home births and the additional time needed to transport blood samples to the hospital for analysis. | Quality: | B |
| Quantity: | B | |
| Consistency: | NA* |
A = good; B = fair; C = weak; NA = not applicable; PIH = pregnancy-induced hypertension
Quality = aggregate of quality ratings for individual studies
Quantity = magnitude of effect, numbers of studies, and sample size or power
Consistency = the extent to which similar findings are reported using similar and different study designs
*
only one study