European Journal of Obstetrics & Gynecology and Reproductive Biology
Review articlePlanned home versus planned hospital births in women at low-risk pregnancy: A systematic review with meta-analysis
Introduction
During the past decades, maternal and neonatal morbidity has markedly reduced thanks to hospitalization of pregnant women in labor, which allows strict monitoring of maternal and fetal wellbeing, reduces the risk of infection, and ensures medical intervention, ranging from amniorrhexis to cesarean delivery. Nonetheless, new interests in home birth have recently arisen in women at low risk pregnancy and the efficacy of medicinal interventions has been questioned. Advantages of home birth consist in fewer vaginal examination, freedom to be mobile during fetal monitoring, expectant management of the third stage of labor, and delayed cord clamping [1]. Medical interventions for low risk pregnancy might be higher than necessary [2]. In contrast, hospital care allows prompt intervention without any delay for transfer and ensures interventions that cannot be provided outside hospitals. Studies, that were conducted in order to analyze perinatal and maternal outcomes according to birth setting, provided conflicting results [[3], [4], [5], [6]]. A Cochrane review showed an increased risk of perinatal mortality [7], whereas a previous Cochrane review did not find significant differences in perinatal death [8]. A meta-analysis also showed that less medical intervention in home births are associated with a higher risk of neonatal mortality [9]. However, the latter did not specify whether the included studies were based on high or low risk pregnancy and whether midwives or obstetricians performed hospital care.
Therefore, we conducted a systematic review and meta-analysis about maternal and perinatal outcomes in home vs. hospital births assisted by midwives.
Section snippets
Methods
Data for this review were identified by searches of PubMed, Scopus Medline, Clinicaltrial.gov, EMBASE, and references from relevant articles using the search terms “home births”, “hospital births”, “neonatal morbidity/mortality”, “maternal morbidity/mortality”, “low risk pregnancy!, ‘midwife care’. Abstract and reports from meetings were included only when they related directly to previously published work. Only articles published in English between January 2000 and June 2017 were included if
Results
We identified 4294 records, and retrieved 937 for a more detailed evaluation after screening titles and abstracts (Fig. 1). We excluded 922, which were aimed to other objectives rather than comparison between planned home and panned hospital births, leaving 15 articles that potentially met the inclusion criteria. Seven articles did not meet at least one inclusion criterion and 8 articles reported usable information included in the review [[1], [4], [10], [11], [12], [13], [14], [15]].
We found
Discussion
This review shows that maternal and neonatal outcomes of women planning to deliver at home are similar to those opting for hospital setting. Post-partum hemorrhage is slightly higher in women delivering at hospital, but this increase does not appear to be clinically meaningful.
Nulliparous women delivering at home are at lower risk of adverse neonatal outcomes compared to those delivered at hospital [16]. We observed lower rates of nulliparous women delivering at home compared to those
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