Birth Safety by the Numbers: Home and Hospital
You Have Given Birth Before
Newborn outcomes by planned place of birth
A Canadian review of four research studies1 that examined the records of more than 45,000 births in Ontario and British Columbia found similar rates in the number of complications and medical interventions experienced by babies regardless of planned birth place. For example, there were similar rates of:
- stillbirths
- infant deaths in the first 28 days of life
- the need for significant resuscitation (providing medical assistance to help the baby breathe, and/or to help its heart beat)
Further, clients who planned to give birth at home were less likely to have a baby with an Apgar score* below 7 at 5 minutes than those who planned to give birth in hospital.
Newborn outcomes by planned place of birth: you have had a baby before
| Newborn outcomes | Planned home birth | Planned hospital birth |
|---|---|---|
| Intrapartum stillbirth and neonatal death within 28 days | 0.8 per 1,000 | 0.4 per 1,000 |
| Resuscitation with positive pressure ventilation and chest compressions | 1.1 per 1,000 | 1.2 per 1,000 |
| Apgar scores < 7 at 5 minutes | 3.7 per 1,000 | 7.4 per 1,000 |
* A score given to a newborn by a health care provider at one and five minutes after birth based on heart rate, respiratory rate, muscle tone, irritability and colour.
Birthing parent outcomes by planned place of birth: you have given birth before
The same Canadian research comparing planned home births with planned hospital births found that a planned home birth was associated with lower rates of certain complications and medical interventions during birth than a planned hospital birth. Planning to give birth at home compared to planning a hospital birth is associated with:
- Higher rates of spontaneous vaginal birth
- Lower rates of caesarean section
- Lower rates of vacuum or forceps delivery
- Lower rates of epidural for pain relief
- Lower rates of postpartum hemorrhage*
- Lower rates of significant perineal trauma**
- Lower rates of episiotomy***
- Lower rates of labour augmentation****
| Birthing parent outcomes | Planned home birth | Planned hospital birth |
|---|---|---|
| Spontaneous vaginal birth | 97.4 | 94.5 |
| C-section | 1.9 | 3.7 |
| Assisted vaginal birth (forceps or vacuum) | 0.7 | 1.8 |
| Episiotomy | 1.2 | 2.4 |
| Labour augmentation | 2.5 | 6.3 |
| Epidural | 4.0 | 16.4 |
| Perineal trauma | 0.3 | 1.0 |
| Postpartum hemorrhage | 2.1 | 2.7 |
*Postpartum hemorrhage: When the birthing parent experiences heavy bleeding after the baby is born.
**Perineal trauma: A tear occurring in the skin and tissues between the vagina and the anus.
***Episiotomy: A cut made to enlarge the vaginal opening just before the baby is born.
****Labour augmentation: An IV (drip) that contains the drug oxytocin to help with the frequency and strength of your contractions for a very slowly progressing labour.
1 Hutton EK, Reitsma AH, Kaufman K. Outcomes associated with planned home and planned hospital births in low-risk women attended by midwives in Ontario, Canada, 2003-2006: a retrospective cohort study. Birth. 2009 Sep;36(3):180–9;
Hutton EK, Cappelletti A, Reitsma AH, Simioni J, Horne J, McGregor C, et al. Outcomes associated with planned place of birth among women with low-risk pregnancies. CMAJ. 2016 Mar 15;188(5):E80–90;
Janssen PA, Lee SK, Ryan EM, Etches DJ, Farquharson DF, Peacock D, et al. Outcomes of planned home births versus planned hospital births after regulation of midwifery in British Columbia. CMAJ. 2002;166(3):315–23;
Janssen PA, Saxell L, Page LA, Klein MC, Liston RM, Lee SK. Outcomes of planned home birth with registered midwife versus planned hospital birth with midwife or physician. CMAJ. 2009 Sep 15;181(6-7):377–83.