Home births in rural areas just as safe as in cities

7 December 2017: Home births may not be more dangerous for healthy rural mothers than for their urban counterparts, a recent U.S. study suggests.

The 18,723 pregnant women in the study all had a low risk of complications, were being cared for by midwives, and planned to deliver their babies at home or in birthing centers. Once researchers adjusted for patient characteristics that can influence birth outcomes for mothers and babies, they didn’t find the odds of complications any higher for rural than for urban women.

“With rural healthcare provider shortages, rural hospital closures, and greater travel distances, it could be expected that there would be an increased time to seek emergency backup care that would result in poorer outcomes,” said lead study author Elizabeth Nethery, a researcher at the School of Population and Public Health at the University of British Columbia.

“What we found instead is that rural women and their babies do not appear to have any added risks when planning a birth at home or in a birthing center compared with nonrural women,” Nethery said by email.

About 22 percent of women in the U.S. live in rural areas with very limited access to obstetric care, researchers note in Birth. Despite declines in hospital-based obstetric services, however, midwifery care at home and in freestanding birthing centers is available in many rural communities.

The current study is the first to look at risks for rural versus urban women who give birth at home or in freestanding birthing centers in the U.S., Nethery said.

Overall, about 95 percent of rural mothers and 94 percent of urban mothers in the study had a normal spontaneous vaginal delivery, the study found.

There wasn’t a meaningful difference in the proportion of women who had vaginal deliveries aided by instruments like forceps or a vacuum.

Almost 5 percent of urban mothers had surgical cesarean section deliveries, compared with less than 4 percent of rural mothers, a difference that was small but statistically meaningful.

In cities, women were also slightly more likely to have serious tearing during delivery or require a transfer to a hospital for more involved medical care. Babies were also more likely stay in the neonatal intensive care unit after urban births.

Limitations of the study include the reliance on women’s residential zip codes to decide whether they lived in an urban or rural area and to estimate how far they might need to travel to a hospital in an emergency, the authors note. In some cases this estimate might not be accurate.

The study was also too small to detect slight but clinically meaningful differences in the chances of rare neonatal complications, the authors note.

Even so, the findings should reassure women that a home birth or birthing center delivery doesn’t need to come with any extra risk of complications, as long as women are appropriately screened for any medical issues that would make a hospital delivery the safer choice, said Erin Wright, a midwife and researcher at Johns Hopkins School of Nursing in Baltimore who wasn’t involved in the study.

“There is a generalized myth about rural communities that tells us that often care is not at the standard in some areas as opposed to urban areas which tend to have a large number of teaching hospitals,” Wright said by email. “This study, specific to these conditions, dispels that myth.”