Birth Safety by the Numbers: Home and Hospital (First Birth)

This is Your First Birth

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 place of birth. 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)
  • Apgar scores (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)

Newborn outcomes

 Planned home birth Planned hospital birth
Intrapartum stillbirth and neonatal death within 28 days 1.9 per 1,000 1.9 per 1,000
Resuscitation with positive pressure ventilation and chest compressions 5.0 per 1,000 4.5 per 1,000
Apgar scores < 7 at 5 minutes 14.7 per 1,000

13.5 per 1,000

 

Birthing client outcomes by planned place of birth

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. For example, 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 use 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****

Birth outcomes by planned place of birth: This is your first birth

Birthing parent outcomes

 Planned home birth Planned hospital birth
Spontaneous vaginal birth 79.6 73.1
C-section 12.8 16.3
Assisted vaginal birth (forceps or vacuum delivery) 7.6 10.6
Episiotomy 9.5 12.4
Labour augmentation 20.3 26.9
Epidural 29.2 44.7
Perineal trauma 3.1 4.7
Postpartum hemorrhage 3.2 3

 

*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.