Is Planned Out-of-Hospital Birth Safer?
- Anne Wallen, Director of MWI
- 4 days ago
- 2 min read
A widely discussed U.S. study published in a prestigious journal appeared to conclude that hospital birth is safer—but a closer examination tells a much more nuanced story. Read on to discover what the study actually found...
You know we love Henci Goer for her smart and comprehensive analysis of studies and stats. We can trust her hot takes on birth outcomes. Let's take a deeper dive into this topic of community vs hospital planned births.
From Henci:
Yet another US study has been published that appears to conclude that hospital birth is safer than home or birth center birth (a.k.a. community birth)—until you look closer.
Objective: “To examine the association between planned place of delivery and perinatal outcomes in Oregon.”
Population: “Planned hospital births vs planned community births.”
Conclusions: “Misclassifying transfers as hospital births may mask risks associated with planned community births.”
What’s wrong with this picture?
Bias against community birth leads to presenting an unbalanced picture of the study’s results.
How can we tell?
The abstract implies hospital birth is safer. Transfers had:
↑ Stillbirth
↑ Ventilator support
↑ Newborn intensive care admission
↑ Any adverse newborn outcome
↑ Instrumental vaginal delivery
↑ Cesarean delivery
What’s problematic about what’s in the abstract?
Transfers are inherently higher risk. All planned community births had similar adverse outcome rates except for:
↑ Ventilator support
But even there:
No ↑ in ventilator support longer than 6 hours
What’s problematic about what isn’t in the abstract?
It omits outcomes strongly favoring community birth. All planned community births had:
↓ Maternal ICU admission
↓ Cesarean delivery (5% vs. 24%)
↓ Instrumental vaginal delivery
↓ Severe perineal tears (the tissue between the base of the vagina and the anus)
What’s problematic about the study’s data?
To determine safety, the proper comparison group is planned low-risk community births with a qualified birth attendant. The study includes data from community births that were:
Not low risk (VBAC labor, high blood pressure)
Attended by other than certified or licensed midwives or physicians
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Read more on her website, and please pick up a copy of the Induction book she recently released that explores LOTS of questions about the WHY, WHEN and HOW!
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