Where will your baby be born: At a hospital? At home? A new well-done study comparing outcomes in or out of the hospital adds a lot of helpful data to the decision-making process. But (sorry), it doesn’t decide the matter once and for all.
The study, just published in The New England Journal of Medicine, is noteworthy because:
- It looked only at low-risk pregnancies—so all of the babies were singletons with their heads down, close to their due dates. High-risk situations where there are clearer indications for possible medical interventions were not included.
- It’s big—the Oregon Health and Science University researchers looked at 80,000 pregnancies.
- It took place in Oregon, which (along with Vermont) has the highest number of out-of-hospital births of any state. In Oregon, 4 percent of all births take place either at home (2.4 percent) or in a birth center (1.6 percent).
- It factored in where the mothers intended to give birth (as opposed to just where the delivery ended up), adding a clearer understanding of the possible trade-offs involved in birth setting.
The winner? Well, the decision still comes down to your appetite for risk and your preferences for your childbirth experience:
If you want to avoid a C-section….
Your odds are much better of avoiding major surgery by staying home. In the Oregon study, 24.7 percent of hospital births—roughly one in four—resulted in a C-section, compared with 5.4 percent outside of hospitals.
Overall in the U.S., 32.7 percent of babies, or nearly one in three, are born via Cesarean, according to Centers for Disease Control and Prevention data. That’s worrisomely high, experts have been saying for years. Between 1996 and 2009 alone, the number of C-sections shot up by 60 percent. A 2012 study found that above 19 percent, there’s statistically no benefit in terms of preventing mothers’ or babies deaths.
If you want to avoid being induced…
Planned out-of-hospital births were associated with fewer interventions all around, including inductions and augmentation of labor, in the Oregon study. On the down side, these moms were at higher risk of blood transfusions, likely due to postpartum hemorrhage.
Only 1.28 percent of all American births take place out of hospitals—but the numbers have been increasing as more women seek to avoid interventions like inductions and C-sections.
If you have a low tolerance for risk…
Though birth never comes with guarantees, the study confirms that the risk of infant death is rare in a low-risk pregnancy—less than .05 percent of births in any setting. “Our findings show that Oregon women are very likely to have a safe delivery in any setting,” lead author Jonathan Snowden says.
Hospital births showed a statistical advantage, however. There were 1.8 deaths per 1,000 among the hospital births, compared to 3.9 per 1,000 among the home births. Hospital-born newborns were also at lower risk of neonatal seizures or need for ventilators.
If you want a less confusing future….
Ultimately it’s not a question of which setting is better for women, researchers and observers have been quick to say. (Babies have been born everywhere for ages.) The real question is how to make birth in either setting better and safer.
To that end, the Oregon researchers—who included two obstetricians, a certified nurse midwife, a nurse, and an epidemiologist—want to see the medical, midwifery, and policy communities do four things:
1) Look more closely at countries like the Netherlands, where maternity care systems led by midwives are more closely integrated with the health system.
2) Develop formal guidelines to better assess who’s an appropriate candidate for an out-of-hospital birth.
3) Improve communication between providers in and out of hospitals.
4) Create an agreed upon transfer system, so moms and babies who need transferring from home to hospital can do so easily.
“We’re never going to make it equally safe, because there’s always emergencies that can occur,” obstetrician Aaron Caughy, a study co-author, told The New York Times. “The biggest thing is going to be improving the trust between hospital providers and out-of-hospital providers.”
Ellen Tilden, the certified nurse-midwife co-author, said she hoped the results “will be used to think about decreasing risk in all birth settings.”
At least everybody’s on the same page about what’s really important here: healthy new moms and healthy new babies, wherever it is they take that first big breath.