In reference to the paper published in BJOG: An International Journal of Obstetrics and Gynaecology today, the Royal College of Obstetricians and Gynaecologists (RCOG) supports home births in cases of low-risk pregnancies provided the appropriate infrastructures and resources are present to support such a system.
Women need to be counselled on the unexpected emergencies (such as cord prolapse, fetal heart rate abnormalities, undiagnosed breech, prolonged labour and postpartum haemorrhage) which can arise during labour and can only be managed in a maternity hospital. Such emergencies would always require the transfer of women by ambulance to the hospital as extra medical support is only present in hospital settings and would not be available to them when they deliver at home.
It is interesting to note the factors identified in the study as risks for intrapartum transfer and for admission to Neonatal Intensive Care Units include birth at 37 or 41 weeks of gestation, a maternal age of 35 or older, women from ethnic backgrounds, low socio-economic status and women who were younger than 25 years.
This new piece of research adds to our understanding of the safety of home births but it is crucial to bear in mind the differences in our (the Dutch and the UK models) respective healthcare systems before further comparisons can be made.
The RCOG looks forward to the results of the Birthplace in England study currently undertaken by the National Perinatal Epidemiology Unit (NPEU) at the University of Oxford. This study will examine the outcomes of birth in different settings.
Reference
de Jonge A, van der Goes B, Ravelli A, Amelink-Verburg M, Mol B, Nijhuis J, Gravenhorst J, Buitendijk S. Perinatal mortality and morbidity in a nationwide cohort of 529 688 low-risk planned home and hospital births. BJOG 2009;116:1–8
To view an abstract of the paper, click here.