Maternity system ‘well equipped’ for home births is key to safe deliveries

Supporters of Aja Teehan and her husband Charles Brand outside the Four Courts last month before Ms Teehan lost a High Court case relating to having a home birth. Photograph: Alan Betson/The Irish Times

Supporters of Aja Teehan and her husband Charles Brand outside the Four Courts last month before Ms Teehan lost a High Court case relating to having a home birth. Photograph: Alan Betson/The Irish Times

Wed, Sep 11, 2013, 10:34

The issue of home births and their safety is a topical one.

The European Court of Human Rights is currently hearing evidence from two Czech women who are claiming they were denied a home birth service, while last month university lecturer Aja Teehan lost a High Court case against the Health Service Executive, after it denied her a home birth on the basis of her having had a previous Caesarean section.

Yesterday’s decision by South Mayo Coroner’s Court to record a misadventure verdict following the tragic death of baby Kai David Williams Heneghan in May 2011 has also placed a spotlight on home births.

A large study by Dutch researchers, published in June, looked at the safety of home births from the mother’s perspective. It measured adverse outcomes such as rupture of the womb, admission to an intensive care unit and the occurrence of major obstetric bleeding.

The results showed that for women who had previously given birth, adverse outcomes were less common among planned home births (one per 1,000) than among planned hospital births (2.3 per 1,000).

Infant mortality
Another recent study of almost 530,000 Dutch women who gave birth at home provided further insights into safety from the babies’ point of view.

Researchers examined the infant mortality rate during the first 24 hours of delivery and during the first week after delivery and found no significant differences between women who gave birth at home with those who had a planned hospital birth.

However, the authors pointed out that women undergoing home births needed to do so as part of a maternity system that is “well equipped” for home births.

A key element is a country’s transport system and geography. Research from Scotland has shown that 30 per cent of first-time mothers required transfer during labour to an obstetric unit for medical attention. It found that timing is crucial and factors such as distance to the nearest maternity unit, the availability of an ambulance for transport and traffic flow are important considerations.

The Birthplace study of 65,000 births in England found home births carried a higher risk for the babies of first- time mothers, with a complication rate of 9.3 per 1,000 births at home compared with a rate of 5.3 for hospital births.

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