Home versus hospital deliveries: follow up study of matched pairs for procedures and outcome. Zurich Study Team.
OBJECTIVE
To assess procedures and outcomes in deliveries planned at home versus those planned in hospital among women choosing the place of delivery.


METHODS
Follow up study of matched pairs.


METHODS
Antenatal clinics and reference hospitals in Zurich between 1989 and 1992.


METHODS
489 women opting for home delivery and 385 opting for hospital delivery; the women comprised all those attending members of the study team for antenatal care and those attending the reference hospital for antenatal care who could be matched with the women planning home confinement.


METHODS
Need for medication and incidence of interventions during delivery (caesarean section, forceps, vacuum extraction, episiotomy), duration of labour, occurrence of severe perineal lesions, maternal blood loss, and perinatal morbidity and death.


RESULTS
All women were followed up from their first antenatal visit till three months after delivery. Referrals during pregnancy (n = 37) and labour (70), changes of mind (15 home to hospital, eight hospital to home), and 17 miscarriages resulted in 369 births occurring at home and 486 in hospital. During delivery the home birth group needed significantly less medication and fewer interventions whereas no differences were found in durations of labour, occurrence of severe perineal lesions, and maternal blood loss. Perinatal death was recorded in one planned hospital delivery and one planned home delivery (overall perinatal mortality 2.3/1000). There was no difference between home and hospital delivered babies in birth weight, gestational age, or clinical condition. Apgar scores were slightly higher and umbilical cord pH lower in home births, but these differences may have been due to differences in clamping and the time of transportation.


CONCLUSIONS
Healthy low risk women who wish to deliver at home have no increased risk either to themselves or to their babies.
Ackermann-Liebrich
U
U
Institute for Social and Preventive Medicine, University of Basle, Switzerland.
Voegeli
T
T
Günter-Witt
K
K
Kunz
I
I
Züllig
M
M
Schindler
C
C
Maurer
M
M
D000022:Abortion, Spontaneous / Q000453:epidemiology; D001034:Apgar Score; D001724:Birth Weight; D002755:Choice Behavior; D005260:Female; D005500:Follow-Up Studies; D019538:Health Care Surveys; D006700:Home Childbirth / Q000401:mortality / Q000706:statistics & numerical data*; D006760:Hospitalization; D006801:Humans; D007223:Infant; D007226:Infant Mortality; D007231:Infant, Newborn; D016555:Matched-Pair Analysis; D007744:Obstetric Labor Complications / Q000453:epidemiology*; D011247:Pregnancy; D011256:Pregnancy Outcome; D011295:Prenatal Care; D013557:Switzerland / Q000453:epidemiology