How does maternity care compare in hospitals versus at home?

A systematic reviewWax, J.R., Lucas, F.L., Lamont, M., Pinette, M.G., Cartin, A., & Blackstone, J. (2010). Maternal and newborn outcomes in planned home birth vs planned hospital births: a metaanalysis. American Journal of Obstetrics and Gynecology, 203(3), 243e1-8. found that the following outcomes are better for women and babies with home birth versus those with hospital birth:

  • Less use of electronic fetal heart rate monitoring.
  • Less use of epidural analgesia.
  • Less use of episiotomy (cut just before birth to widen opening of vagina).
  • Less experience of any tear in the perineum (area between opening of vagina and anus).
  • Less experience of serious tears into or through the anus, or tears in the vagina.
  • Less use of vacuum extraction or forceps.
  • Less use of cesarean birth.
  • Less experience of excess bleeding.
  • Less experience of placenta that does not come out.
  • Less experience of infection.
  • Less experience of preterm birth.
  • Less experience of low birth weight.

In a systematic review,Wax, J.R., Lucas, F.L., Lamont, M., Pinette, M.G., Cartin, A., & Blackstone, J. (2010). Maternal and newborn outcomes in planned home birth vs planned hospital births: a metaanalysis. American Journal of Obstetrics and Gynecology, 203(3), 243e1-8. the following outcomes were not different between women and babies in hospitals and with home birth:

  • Umbilical cord coming out before birth (cord prolapse, a serious complication).
  • Newborn large for gestational age.
  • Newborn requiring ventilation.
  • Perinatal death (stillbirth from 20 or more weeks plus newborn death in first 28 days).

A systematic reviewWax, J.R., Lucas, F.L., Lamont, M., Pinette, M.G., Cartin, A., & Blackstone, J. (2010). Maternal and newborn outcomes in planned home birth vs planned hospital births: a metaanalysis. American Journal of Obstetrics and Gynecology, 203(3), 243e1-8. found two outcomes that were worse for women giving birth at home:

  • More “post-term” births at or beyond 42 weeks.
  • More newborn death (in first 28 days).

Note: This finding regarding newborn death risk has been very controversial. It is based on studies that have been criticized (for example, for including high-risk, unplanned, out-of-hospital births) and is based on a relatively small number of births. As the perinatal death rate, which did not differ between home and hospital, was based on 20 times more home births, it is likely to be a more trustworthy result.

A structured review found that resource use was generally lower for women cared for at home due to lower rates of intervention and no facility costs.Henderson, J. & Petrou, S. (2008). Economic implications of home births and birth centers: a structured review. Birth, 35(2), 136-146.

A systematic review reported rates of transport of women or newborns during or after labor from planned home birth care to hospital care. Overall, transport in the various studies ranged from 10 percent to 32 percent, with emergency transport ranging from 0 percent to 5 percent. The most common reason was poor labor progress.Blix, E., Kumle, M., Kjaergaard, H., Oian, P., & Lindgren, H.E. (2014). Transfer to hospital in planned home births: a systematic review. BMC Pregnancy and Childbirth, 14, 179.