Are home births safe? The pros and cons explained by mums

If you've given birth in a hospital before, you're well within your right to wonder "are home births safe?".

For many women, the thought of giving birth - particularly the first time - is terrifying. Hospital bags are packed weeks before your due date, and plans are made for every eventuality, as every possible scenario runs through your mind.

In most cases, these scenarios will most likely involve a hospital bed and a doctor. But can you imagine what it would be like if it didn't? Imagine what it would be like giving birth at home.

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Just 50 years ago, over 30% of babies were born at home, usually with the assistance of midwives and district nurses. Today, in the UK the home birth figure stands at a little over 2%. In the US it stands at a little over one, although some states do not allow the practice.

Are home births safe?

But one question remains controversial - how safe is a home birth? The subject of medical, scientific and lunchroom debates for years, it’s a difficult question to answer.

Without fail, everyone has some kind of answer to the debate, each informed by their own anecdotes and experiences.

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At the forefront of many expectant mother's mind when deciding to opt for a home birth is what might happen if something were to go wrong.

Quite understandably, the presence of a whole team of doctors, midwives and a specialist kit is reassuring for many women. Pregnancy is, after all, an inherently risky process and it's nice to know you're giving yourself, and your child, the best chance of survival.

This is a position that many doctors agree with, occasionally leading to accusations that they too often push women towards hospital births unnecessarily.

What does the science say?

But despite the criticism, the figures suggest that, in some cases, doctors may be right.

During a large-scale study, published in 2011, it was found that for first-time mothers, the risk of an “adverse outcome” was higher during home birth than for those who delivered their baby in a hospital.

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For those having subsequent children, there was no difference. But it must be considered that this may be, in part, because mothers who have had a difficult first birth are advised against a home birth the second time around.

Midwives weigh in...

However, there are some that believe that the atmosphere of a hospital can actually increase the risks associated with giving birth.

Annie Francis, who was model Lily Cole’s midwife during the home birth of her daughter, is among them, arguing that bright, loud labour wards are the opposite of a “natural” birthing environment:

"As mammals, we birth well when our hormones flow normally, and for that to happen we need quiet, dark spaces supported by people we know," she told The Telegraph. The absence of this, she says, may cause "anxiety levels go through the roof and you have a dysfunctional labour."

What do mothers have to say about their experiences?

Mihal-Greener, an Australian woman living in the Netherlands, which has the highest home birth rate in the developed world, explained the ways in which giving birth in the comfort of her own flat gave her more control over her labour:

"Avoiding the car ride to the hospital. Not sharing a room with three other moms and their crying babies."

She continued: "Not worrying if I forgot something in my hospital bag. Not having a nurse wake me with a flashlight on her midnight rounds. Sleeping in my own bed. Not being subjected to hospital food. Being allowed outside to get some fresh air."

Yet, home birth rates in the Netherlands are in decline, something that has been put down to an increasing demand for pain relief, which is not available to women who choose to give birth at home. This is because only doctors can administer anaesthetics, including epidurals.

Do the risks of home births vary from country?

The risks - or lack thereof - to mother and child also seems to vary by country.

In the USA, where the shift from home birth to hospital birth has been credited with a 90% decrease in neonatal mortality over the 20th century, it seems to carry a higher risk than in other developed nations; the perinatal death rate in the country is three times higher in cases of home birth than in hospitals.

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In some states, it is up to seven times higher. The American College of Obstetricians and Gynaecologists have even gone so far as to declare that "choosing to deliver a baby at home… is to show a preference for the process of giving birth over the goal of having a healthy baby".

Yet in Canada, a 2015 study by McMaster University indicated that women with low-risk pregnancies who gave birth at home were at no greater risk than those who gave birth in hospital.

Further, the UK's National Institute for Health and Clinical Excellence (NICE) said that in certain cases, it may even be lower risk.

While mortality rates are higher in the developing world, where the practice is still commonplace, research has shown that wherever you are in the world, home birth is safer for women from more affluent socio-economic backgrounds than those from lower-income groups.

Home births are generally not advisable for women with certain health concerns

Another common thread is that the mother's pre-existing health can determine the safety of any home birth.

Women with certain health concerns will normally be advised to give birth in a hospital. This is because they are at higher risk of something going wrong. Such conditions include epilepsy, high blood pressure and diabetes.

The same is true for women who have previously experienced a difficult labour.

The bottom line

Like with most things in life, there are pros, cons and influencing factors at every turn. All we can ask for is clear, honest and accurate information, un-muddled by personal opinion.

Ultimately, the final decision belongs to the mother. Where a woman gives birth, whether that be at home or a hospital ward, is hers and hers alone.