In comparison to midwife- and physician-assisted hospital births, the rate of perinatal death is low for those who arrange for home-based child birth with a registered midwife in attendance, new research shows.

Perinatal death rate per 1,000 arranged home births was 0.35 compared with 0.57 for midwife-aided hospital births, or 0.64 for physician-assisted hospital births.

The new research, published online in the Canadian Medical Association Journal, re-ignites the debate about safety issues surrounding home births. In the US, the American College of Obstetricians and Gynecologists continues to stand against the practice.

Patricia A. Janssen, PhD, of the University of British Columbia, and colleagues collected data from 2000-2004 for planned home births in British Columbia where a registered midwife was present. Home birth requirements, set forth by the College of Midwives of British Columbia, included no preexisting or pregnancy-onset maternal disease, a singleton fetus, and gestational age between 36 and 41 weeks.

A total of 2,899 women scheduled for home births were compared with 4,752 who chose to have a midwife-assisted hospital birth. The same group of midwives were involved in both sets of births. Another comparison group of 5,331 physician-assisted hospital births were also involved in the study.

Of women intending to birth their child at home, 78.8% were able to keep their plans. Of those intending a hospital birth, 96.9% followed through on intentions. For home births assisted by midwives, there was much less chance of third- or fourth-degree perineal tear, postpartum hemorrhage and pyrexia, compared with midwife-assisted hospital birth. Birth trauma, resuscitation and oxygen therapy beyond 24 hours also were less likely in the home birth set of mothers. Infection rates were similar in the two groups.

Funding for the study came from the Canadian Institutes of Health Research.