Study challenges safety concerns over planned home births for low-risk pregnancies

In low-risk pregnancies, mothers and children are just as safe with a planned home birth as they are with a planned birth center birth, a national study led by Oregon State University researchers has shown.

The findings, published in Medical Care, contradict doctors’ long-held concerns about home birth, including a recent opinion by the American College of Gynecologists and Obstetricians that describes hospitals and accredited birth centers as the safest places to have a baby. A birth center is a health care facility designed to provide a more natural and home-like environment than a hospital.

OSU scientists analyzed two national registries for community births—planned birth either at home or in a birth center for low-risk pregnancies—in the largest study to examine how the settings compared to each other in terms of health outcomes.

A low-risk pregnancy is defined as a single baby being carried to full term (at least 37 weeks) and positioned with its head down, with no major maternal complications such as diabetes or pre-eclampsia. At least 70% of pregnancies are low risk, said Marit Bovbjerg, an associate professor in the Oregon State College of Health.

Combined, the two registries documented more than 110,000 births from 2012 to 2019, representing all 50 U.S. states, and the data showed no safety difference between home birth and birth center birth.

“Historically, physicians in the U.S. have objected to planned home births but not planned birth center births, even though from both settings you would need to transfer the birthing person to a hospital for any major complications,” Bovbjerg said. “Until now, we’ve had no evidence about home versus birth center outcomes. Our study is the first to provide evidence that these two birth settings are equally safe.”

Bovbjerg and Melissa Cheyney, a professor in the OSU College of Liberal Arts and a licensed midwife, did not directly compare the safety of community settings to hospitals, but they note that the bulk of evidence globally, including a U.S. National Academies of Science, Engineering and Medicine report published in 2020, supports the idea that planned community birth is a safe alternative to hospital birth.

“That means that within the U.S., we already had evidence that birth centers were comparable to hospitals for low-risk births,” said Bovbjerg, who with Cheyney co-directs Oregon State’s Uplift Lab. “Our study compared home to birth center and suggests that both community settings are a reasonable choice for low-risk birthing people.”

The scientists note that the rate of home birth in the United States has been increasing over the last two decades, and that 2% of births in the U.S. happen in one of the two types of community settings, which have similar attendants and interventions available but different practice standards, regulatory guidelines and levels of health systems integration.

They added that planned home birth resulted in a lower rate of transfer to hospital than planned birth center birth for reasons that could relate to concern over negative hospital experiences.

“They might fear a loss of continuity of care provider, as well as possible mistreatment and judgment upon arrival at the hospital,” Cheyney said, citing a national care-experience study in which many participants reported mistreatment, including being ignored, scolded, shouted at or subject to an invasive procedure without consent.

“That was especially true for Black and Indigenous people who transferred to a hospital from a planned home birth,” she said. “If previous hostile transfer experiences contribute to a reluctance to transfer, we obviously need to work together to improve the transfer experience. Transfer from community settings is often necessary, and anything that discourages a necessary transfer likely causes harm.”

The collaboration also included researchers from the American Association of Birth Centers, Georgia State University, Frontier Nursing University, the University of Denver and the University of British Columbia.

In low-risk pregnancies, mothers and children are just as safe with a planned home birth as they are with a planned birth center birth, a national study led by Oregon State University researchers has shown.

The findings, published in Medical Care, contradict doctors’ long-held concerns about home birth, including a recent opinion by the American College of Gynecologists and Obstetricians that describes hospitals and accredited birth centers as the safest places to have a baby. A birth center is a health care facility designed to provide a more natural and home-like environment than a hospital.

OSU scientists analyzed two national registries for community births—planned birth either at home or in a birth center for low-risk pregnancies—in the largest study to examine how the settings compared to each other in terms of health outcomes.

A low-risk pregnancy is defined as a single baby being carried to full term (at least 37 weeks) and positioned with its head down, with no major maternal complications such as diabetes or pre-eclampsia. At least 70% of pregnancies are low risk, said Marit Bovbjerg, an associate professor in the Oregon State College of Health.

Combined, the two registries documented more than 110,000 births from 2012 to 2019, representing all 50 U.S. states, and the data showed no safety difference between home birth and birth center birth.

“Historically, physicians in the U.S. have objected to planned home births but not planned birth center births, even though from both settings you would need to transfer the birthing person to a hospital for any major complications,” Bovbjerg said. “Until now, we’ve had no evidence about home versus birth center outcomes. Our study is the first to provide evidence that these two birth settings are equally safe.”

Bovbjerg and Melissa Cheyney, a professor in the OSU College of Liberal Arts and a licensed midwife, did not directly compare the safety of community settings to hospitals, but they note that the bulk of evidence globally, including a U.S. National Academies of Science, Engineering and Medicine report published in 2020, supports the idea that planned community birth is a safe alternative to hospital birth.

“That means that within the U.S., we already had evidence that birth centers were comparable to hospitals for low-risk births,” said Bovbjerg, who with Cheyney co-directs Oregon State’s Uplift Lab. “Our study compared home to birth center and suggests that both community settings are a reasonable choice for low-risk birthing people.”

The scientists note that the rate of home birth in the United States has been increasing over the last two decades, and that 2% of births in the U.S. happen in one of the two types of community settings, which have similar attendants and interventions available but different practice standards, regulatory guidelines and levels of health systems integration.

They added that planned home birth resulted in a lower rate of transfer to hospital than planned birth center birth for reasons that could relate to concern over negative hospital experiences.

“They might fear a loss of continuity of care provider, as well as possible mistreatment and judgment upon arrival at the hospital,” Cheyney said, citing a national care-experience study in which many participants reported mistreatment, including being ignored, scolded, shouted at or subject to an invasive procedure without consent.

“That was especially true for Black and Indigenous people who transferred to a hospital from a planned home birth,” she said. “If previous hostile transfer experiences contribute to a reluctance to transfer, we obviously need to work together to improve the transfer experience. Transfer from community settings is often necessary, and anything that discourages a necessary transfer likely causes harm.”

The collaboration also included researchers from the American Association of Birth Centers, Georgia State University, Frontier Nursing University, the University of Denver and the University of British Columbia.