Is Hospital Birth Safer?

A friend of mine is a few days beyond her due date and is planning another homebirth. She sees her midwife but also sees her physician who tries to talk her into giving birth at the hospital instead of at home. Compared to the comfort and the peace of a home birth setting, the hospital simply has nothing to offer to her. However, she has maintained an ongoing relationship with her physician so that she is familiar with her doctor and the birth environment if she unexpectedly needs to go to the hospital.

This brings up an interesting question. Just how safe is hospital birth compared to home birth? Many health care providers and parents alike believe that the hospital is the safest place to be because of the availability of medical personnel and equipment in the event of any complications. Homebirth advocates, however, believe that the safest place to give birth and avoid unnecessary inverventions that lead to some complications is the home. And even some mothers choose to avoid using a health care provider at all and choose to have an unattended birth, either alone or with their partner helping to catch the baby.

The only certain way of answering this question, "Is hospital birth safer?", would be a randomized controlled trial (RCT). This could have been done in the 1950s but such a trial of home versus hospital was not suggested. Such a suggestion has now been made but it would require 500,000 women in a trial to answer the safety question. This is patently impossible so we make do with data that may suffer from the bias that women choosing home birth may be different from women choosing hospital, however well one may try to match them.

Nevertheless, one can look at the outcomes in relation to place of birth. One of the first to do so was Marjorie Tew, a statistician working at Nottingham Medical School. In her large-scale and detailed study, she analysed data from the 1970 British Births Survey and compared perinatal death rates in different places of birth (Tew, M. (1980). Place of birth and Perinatal mortality. Journal of the Royal College of General Practitioners, 35). She recognized that one would expect more "high-risk" deliveries in hospitals than at home. Tew attempted to control for this by using both antenatal and labour prediction scores to categorize expected risk ....

Tew found that babies were more likely to survive if born in a GP or at home, rather than in hospital, at all levels of risk scores. Only at the very highest level of risk were the better results at home and in GP units not statistically significant.

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