Exploring the Dispute over Home Birth Safety: A Critical Review of Recent Cohort Studies

Background: Within developed nations, the majority of births are delivered within hospital care settings.  However, over the past decades, there has been a growing debate within the medical community regarding the safety of home births compared to hospital births.  Though there has been a significant increase in the literature, policy markers must formulate their best recommendations on these conflicting findings. The objective of this review is to contribute to and inform the debate by providing an assessment of the methodological approaches and results from the most recent, largest and well-designed observational studies that compare outcomes of home births to those of hospital births.  Methods: Of the 47 studies exploring home births vs. hospital births, we selected 11 based on selected outcomes and time period.  The selected studies are compared on perinatal/neonatal and intrapartum mortality, Apgar score, and admission to neonatal intensive care unit (NICU).  The studies were grouped based on whether they identified a difference, found no difference, or had mixed results between the selected comparison groups.  Results: The studies examined do suggest that there is a greater risk of mortality during home births, but after the intrapartum period no differences in safety were detected.  Conclusions: Based on the findings of these studies, home births have the potential to be a viable safe option for low-risk women.  However, in order to improve this option’s acceptability, it should be integrated into a national or regional healthcare system.