Table 9

Impact of home births with skilled attendance versus hospital births on stillbirths and perinatal mortality

Source

Location and Type of Study

Intervention

Stillbirths/Perinatal Outcomes


Reviews and meta-analyses


Hodnett et al. 2005 [111]

Australia, Scotland, UK, Sweden and Canada.

Meta-analysis (Cochrane). 5 RCTs included (N = 8529 participants).

To assess the effects of care in a home-like birth environment (intervention) vs. care in a conventional labour ward (controls).

PMR: RR = 1.83 (95% CI: 0.99–3.38) [NS].

[41/5288 vs. 13/3241 in intervention and control groups, respectively].


Olsen 1997 [113]

Switzerland, USA, Essex, Australia.

Meta-analysis (non-Cochrane). 6 controlled

observational studies included (N = 24,092 low-risk pregnant women).

Assessed the safety of planned home birth backed up by a modern hospital system (study group) compared with planned hospital birth (controls).

PMR: OR = 0.87 (95% CI: 0.54–1.41) [NS].


Intervention studies


Janssen et al. 2003 [115]

Canada. University of British Columbia (Home Birth Demonstration Project).

Intervention study. N = 2,178 pregnant women (N = 864 Home Birth Project clients, N = 571 midwife-attended hospital, N = 743 physician-attended hospital deliveries).

Compared the effect on the outcomes of women remaining eligible for home birth at the onset of labour (intervention) vs. those women meeting eligibility requirements for home birth but planning instead to deliver in hospital with either a midwife or physician in attendance (controls).

PMR: adj. OR = 2.50 (95% CI: 0.27–24.5) [NS]

[0.3% vs. 0.1% in intervention vs. physician-attended hospital birth, respectively].

PMR: 0.3% vs. 0% in home birth vs. midwife-attended hospital birth respectively.


Observational studies


Janssen 2002 [165]

Canada.

Prospective cohort study. N = 2,176 pregnant women (N = 862 home birth, N = 571 midwife-attended hospital, N = 743 physician-attended hospital births.

Compared the impact on pregnancy outcomes of planned home births (exposed group) vs. planned hospital births either attended by midwife (unexposed # 1) or the physician (unexposed # 2).

SBR: 2 vs. 0 vs. 1 in the exposed, unexposed # 1 and unexposed # 2 groups, respectively.

PMR: 3 cases in the home birth group (2 stillbirths and one neonatal death).

PMR: RR = 2.5 (95% CI: 0.27–24.5) in exposed vs. unexposed # 2.


Tracy et al. 2007 [116]

Australia. Population-based study.

Retrospective cohort. Women (N = 1,001,249) who gave birth in Australia during 1999 to 2002. Of these women, 21,800 (2.18%) gave birth in a birth center.

Compared the impact on perinatal mortality of giving birth in "alongside hospital" birth centers (exposed group) vs. birth in the hospitals (unexposed group).

PMR: 1.51/1000 vs. 10.03/1000 in exposed vs. unexposed groups, respectively (statistically significant).

PMR: 1.4/1000 vs. 1.9/1000 among term births to primiparas in exposed vs. unexposed groups, respectively.

PMR: 0.6/1000 vs. 1.6/1000 among term births to multiparas in birth centers vs. hospitals, respectively.


Wiegers et al. 1996 [117]

Netherlands.

Prospective study. Women (N = 1836) and midwives (N = 97).

Compared the impact of planned home birth (study group) vs. planned hospital birth (controls).

PMR: 0/471 (0%) vs. 2/369 (0.5%) among primiparous women in the study vs. control groups, respectively.

PMR: 4/669 (0.6%) vs. 0/327 (0%) among multiparae in the study vs. control groups, respectively.

Multiparae had significantly better perinatal outcome for planned homebirths than planned hospital births (t = 4.75, p < 0.001).


Bhutta et al. BMC Pregnancy and Childbirth 2009 9(Suppl 1):S7   doi:10.1186/1471-2393-9-S1-S7

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