Meta-analysis of observational studies: safety of home birth

Tags: Oral
Olsen O

Introduction: Archie Cochrane awarded 'the wooden spoon' to obstetrics, partly because 'The specialty missed its first opportunity in the sixties to randomise the confinement of low risk pregnant women at home and in hospital'.

Objective: To examine the safety of planned home birth backed up by a modern hospital system compared with planned hospital birth.

Methods: Meta-analysis of 6 controlled observational studies. Confounding was controlled either through restriction, matching or in the statistical analysis. Setting: The Western World. Subjects: 24092 selected and primarily low risk pregnant women. Main outcome measures: Perinatal mortality supplied with morbidity measures: Apgar score and maternal laceration. Intervention rates were noted.

Results: The perinatal mortality was not significantly different in the two groups (OR=0.87, 95% Cl 0.54-1.41). The principal difference in the outcome was a lower incidence of low Apgar scores (OR=0.55; 0.41-0.74) and a lower incidence of severe lacerations (OR=0.67; 0.54-0.83) in the home birth group. Medical interventions were much less common in the home birth group: induction (statistically significant ORs in the range (0.06-0.39), augmentation (0.26-0.69), episiotomy (0.02-0.39), operative vaginal birth (0.03-0.42) and caesarean section (0.05-0.31). No maternal deaths were observed in any of the studies. Some of the differences may be partly due to bias. However, the findings regarding morbidity are supported by randomised clinical trials of elements of birth care relevant for home birth, and the finding relating to mortality is supported by large register studies comparing variously specialised hospital settings.

Discussion: Home birth offers a safe and acceptable alternative to hospital confinement for selected pregnant women, and reduces the incidence of medical interventions.