American College
of  Community Midwives 

A professional organization for Community Midwives

Home birth safety, outcomes comparable to hospital births for most pregnancies

BJOG: An International Journal of Obstetrics and Gynecology 2009; Advance online publication ~ Posted: 20 April 2009

Comparing perinatal mortality and severe perinatal morbidity between planned home and hospital births among low-risk women initiating labor in primary care.

MedWire News: Planning a home birth does not increase the risks for perinatal mortality and severe perinatal morbidity among low-risk women, suggest Dutch study results.

“We conclude that women can safely choose where they want to give birth, provided the maternity care system is well equipped for homebirths,” said study co-author Simone Buitendijk (TNO Quality of Life, Leiden).

The Dutch nationwide cohort study of 529,688 low-risk women who were in primary midwife-led care at the onset of labor found no significant differences between planned home (60.7 percent) and planned hospital (30.8 percent) births regarding: intrapartum death, intrapartum death and neonatal death during the first 24 hours and up to 7 days, and admission to the neonatal intensive care unit (NICU).

The risk for poor outcomes (intrapartum and neonatal death 0-7 days and admission to NICU) was increased in women who were: primiparous versus multiparous (0.08 vs 0.05 percent and 0.26 vs. 0.13 percent), gave birth at 37 (0.12 vs. 0.06 percent and 0.34 vs. 0.16 percent) or 41 weeks’ (0.09 vs. 0.06 percent and 0.23 vs. 0.16 percent) compared with 38-40 weeks’ gestation, and who were older than 35 years compared with 25-34 years (0.09 vs. 0.06 percent and 0.21 vs. 0.71 percent).

In a supporting statement, the UK’s Royal College of Obstetricians and Gynecologists said that it supports home births in low-risk pregnancies, “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.”

This issue is currently being addressed by the Birthplace in England study undertaken by the National Perinatal Epidemiology Unit at the University of Oxford, UK.

MedWire ( is an independent clinical news service provided by Current Medicine Group, a part of Springer Science+Business Media. © Current Medicine Group Ltd; 2009

Upright position during first stage of labor shortens labor time

Cochrane Database of Systematic Reviews
2: CD003934   Posted: 20 April 2009

Assessing the effects of different upright and recumbent positions and mobilization for women in the first stage of labor on length of labor, type of delivery and obstetric outcomes.

MedWire News: Walking and upright positions during the first stage of labor may reduce labor length and do not seem to be associated with increased intervention or negative effects on mothers’ and infants’ wellbeing.

Observational studies have suggested that a recumbent position during labor may have adverse effects on uterine contractions and impede progress in labor.

To investigate further, Cochrane researchers Annemarie Lawrence (The Townsville Hospital, Douglas, Australia) and co-authors analyzed data from 21 studies, involving 3,706 women, carried out in developed countries since the 1960s.

The researchers found that overall, the first stage of labor was approximately 1 hour shorter for women randomly assigned to upright as opposed to recumbent positions. Women in upright positions were also less likely to have epidural analgesia (relative risk = 0.83).

There were no differences between groups for other outcomes including length of the second stage of labor, mode of delivery, or other obstetric outcomes.

“Based on these results, we would recommend that women are encouraged to use whichever positions they find most comfortable, but are specifically advised to avoid lying flat,” said Lawrence.

The authors caution that since there were high levels of heterogeneity when studies were pooled, “results need to be interpreted with caution.”

MedWire ( is an independent clinical news service provided by Current Medicine Group, a part of Springer Science+Business Media. © Current Medicine Group Ltd; 2009

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