Labour has a reputation for being painful. Personally, I like pain relief and avoiding complications, so I chose to give birth in what I thought were the safer environs of the hospital. But in hospitals, medical staff may be rather too close to hand, and this can mean a higher risk of medical intervention without, necessarily, much benefit. The issue of Caesarean sections is a particularly sore point in this area. A number of women find themselves told to have one when they would rather not, and vice versa. Some patients are now electing to avoid the antenatal ward altogether, in the hopes of an equally safe, but less invasive birth at home.

This choice is more weighted than others since, when talking about labour, there are two people to be considered – the mother and the child. In the UK we are allowed to decline medical treatment even if it leads to our death. In fact, forcing treatment on someone who has decided against it could be construed as battery or assault. Start applying this logic to childbirth, though, and everything becomes less clear.

So, is there a discernibly greater chance of things going wrong at home? A cohort study, published this year in the British Journal of Obstetrics and Gynaecology, examined the differences in perinatal (in the time just before or after birth) mortality and morbidity in more than half a million women planning either hospital or home births in the Netherlands. They concluded that “planning a home birth does not increase the risks of perinatal mortality and severe perinatal morbidity among low-risk women” provided there was an “availability of well-trained midwives and a good transportation and referral system”.

However, another important proviso comes out of a paper recently published in the British Medical Journal. This study, based in Dundee, compared women who decided to use an independent midwife with similar women who had standard NHS care. The researchers wanted to know about differences in perinatal outcomes. This was a smaller study than the Dutch one, involving the analysis of about 8,700 records. Women employing independent midwives had higher rates of breast-feeding and spontaneous, rather than induced, births. But the mortality rate of babies in this group was comparatively higher – 1.7 per cent of women in the independent midwives group had a stillbirth or neonatal death, versus 0.6 per cent in the NHS group. However, when the “high-risk” women were excluded from each cohort – for example, women with previous complications or twins – there was no significant difference in mortality rates. This area of research requires further study. But we have to wonder: should the choice to have a high-risk home birth exist at all?

Margaret McCartney is a GP in Glasgow.
margaret.mccartney@ft.com

Margaret McCartney is joint winner of the European School of Oncology’s Best Cancer Reporter for 2009. www.cancerworld.org

For lively discussion of the latest medical issues go to Margaret McCartney’s blog at blogs.ft.com/healthblog