Hospital or Home Birth?

Stephanie Specht's picture
By Stephanie Specht on January 7, 2016

As more and more women consider home births, the question of safety often arises. How safe is it to have a baby outside of the hospital?

A new study in the New England Journal of Medicine analyzed nearly 80,000 births in Oregon to try and find the answer. The study found that while the rate of complications in all locations was low, planned out-of-hospital births were riskier overall. Specifically, 3.9 out of 1,000 planned out-of-hospital births were followed by the infant's death within four weeks, compared with 1.8 of 1,000 among planned hospital births.

The report went on to note that out-of-hospital births also carried a greater risk of neonatal seizures and increased the chances that newborn babies would need ventilators or mothers would need blood transfusions. However, women having out-of-hospital births were far less likely to have cesarean sections — 5.3 percent compared with 24.7 percent in a hospital. Out-of-hospital births also involved fewer interventions to hurry labor along and mothers had fewer lacerations.

“This study is helpful because it gives parents the necessary statistics to make an informed decision to decide what risks they are willing to accept to have the birth experience that they want,” said Kelley Morel, M.D., of Carilion Clinic’s Obstetrics and Gynecology. “Some women may focus on the overall low rate of infant death in the home-birth setting while others will find the 2.4 times increased risk of infant death to be alarming.”  

Conducted by a team consisting of two obstetricians, a nurse, an epidemiologist and a certified nurse midwife at Oregon Health and Science University, the study analyzed 79,727 births in 2012 and 2013 in Oregon, which has one of the country’s highest home birth rates. The breakdown of those births is as follows:

  • 75,923 women delivered in a hospital as planned
  • 3,203 delivered outside a hospital as planned, including almost 2,000 at home
  • 601 women planned out-of-hospital births but were transferred to hospitals

Births involving premature or breech delivery, birth defects and twins were excluded from the study. To rule out any factors that could explain delivery problems, the study took into account pregnancy risks, such as diabetes or hypertension, as well as a woman’s age and race.