Many surveys carried out in the Western world have recorded that the level of maternal satisfaction with the process of giving birth is higher if a planned delivery takes place at home, where the mother-to-be is relaxed, in control and not separated from her family. The resulting production of endorphins, rather than the adrenaline production that hospitalisation tends to stimulate, reduces the need for both pain relief and other medical interventions. However, such a home-planned delivery normally presupposes that the expectant mother is low risk, and that the pregnancy is straightforward. It also presupposes that an experienced certified midwife will be available as soon as s/he is needed.
Many studies have shown that if the necessary infrastructure is in place, planned home births for low risk women are as safe as hospital births, but because other authors have questioned safety (probably because data combined both planned and unplanned home births), the subject has remained controversial in most Western countries. Now the largest and most carefully designed study carried out so far, involving 530,000 Dutch women, has recently been published. It clearly demonstrates that for low risk women a planned home delivery is as safe as a hospital delivery. In countries with higher rates of nosocomial infections than in the Netherlands, a prudently planned home delivery is probably even safer than a hospital delivery.
So what, then, is the problem? Firstly some healthcare providers have guaranteed women the choice of a home birth without having enough midwives to support them, nor suitable infrastructure to deal quickly with emergencies should they arise. Yet nearly a third of women who planned a home birth and commenced labour at home in the large Netherlands study needed to be transferred to hospital, not only because of foetal or maternal complications, but also because many were unable to cope with the currently fashionable ‘natural birth’ and required effective pain relief. In the Dutch study transfer to hospital was not found to have an impact on maternal and neonatal mortality, though understandably the level of maternal satisfaction was lower. However in a study spanning ten years carried out in the UK, where transport links are not as smooth as in the Netherlands, the neonatal death rate when mothers were transferred to hospital was significantly higher than for planned hospital births.
Over half a million pregnant/delivering women and four million neonates die each year. More accessible hospitals in the resource-poor countries would substantially reduce this toll. Whilst the Western desire for maternal satisfaction is not trivial, surely the most important outcome of a pregnancy is a healthy mother and baby.