Home versus hospital deliveries: follow up study of matched pairs for procedures and outcome

Abstract

Objective: To assess procedures and outcomes in deliveries planned at home versus those planned in hospital among women choosing the place of delivery. Design: Follow up study of matched pairs. Setting: Antenatal clinics and reference hospitals in Zurich between 1989 and 1992. Subjects: 489 women opting for home delivery and 385 opting for hospital delivery; the women comprised all those attending members of the study team for antenatal care and those attending the reference hospital for antenatal care who could be matched with the women planning home confinement. Main outcome measures: Need for medication and incidence of interventions during delivery (caesarean section, forceps, vacuum extraction, episiotomy), duration of labour, occurrence of severe perineal lesions, maternal blood loss, and perinatal morbidity and death. Results: All women were followed up from their first antenatal visit till three months after delivery. Referrals during pregnancy (n = 37) and labour (70), changes of mind (15 home to hospital, eight hospital to home), and 17 miscarriages resulted in 369 births occurring at home and 486 in hospital. During delivery the home birth group needed significantly less medication and fewer interventions whereas no differences were found in durations of labour, occurrence of severe perineal lesions, and maternal blood loss. Perinatal death was recorded in one planned hospital delivery and one planned home delivery (overall perinatal mortality 2.3/1000). There was no difference between home and hospital delivered babies in birth weight, gestational age, or clinical condition. Apgar scores were slightly higher and umbilical cord pH lower in home births, but these differences may have been due to differences in clamping and the time of transportation. Conclusion: Healthy low risk women who wish to deliver at home have no increased risk either to themselves or to their babies. Interventions (induction, caesarean section, medication, forceps, or vacuum extraction) may be considerably less frequent in women who originally opt for home delivery There are no obvious disadvantages of home delivery for mother or child when the mother opts for home delivery More studies are needed to look into the small risks of death, serious bleeding, and complications of interventions, which could not be evaluated in this study owing to limited power