15 March 2023

Hospital births can do more harm than good

A new summary of the best available research published in the internationally recognized Cochrane Library shows that planned hospital births can do more harm than good. This applies if the pregnant woman is healthy, expects an uncomplicated birth, and the birth takes place in a well-organized health care system. The summary was written by senior researcher Ole Olsen, Research Unit for General Practice, in collaboration with midwife and PhD Jette Aaroe Clausen.

Planned hospital births increase the number of complications and interventions without achieving any demonstrable benefit in terms of lower maternal or child mortality.

Most pregnant women are healthy and could plan a home birth. Among women who nevertheless plan a hospital birth the risk of major bleedings in connection with the birth is increased around 50% and the risk of infections afterwards is also increased around 50%.

The risks for various interventions during childbirth are also increased, e.g. for electronic fetal the risk is tripled, for augmentation, epidural anaesthesia and episiotomy each, it is increased by around 50%, whereas it is increased by about 20% for caesarean section.

For the children, the risk of having an electrode screwed into the scalp is twice as high. For children of second time mothers, the risk of being admitted to the neonatal unit is increased by around 20%.

The risk of having difficulties establishing breastfeeding is increased by more than 50% for those who give birth in hospital.

The figures above are based on women who expect an uncomplicated birth, but still choose to plan a hospital birth, compared to similar women who choose a home birth; with the additional condition that all interventions and complications in the home birth group are counted as belonging to the home birth group, also for women who are transferred to hospital.

The World Health Organization (WHO) has raised concern that the increasing medicalisation of childbirth tends to undermine women’s own capability to give birth and negatively impacts their childbirth experience.

Stated in simple words: Birth runs more smoothly when it is planned to start at home; here is the necessary space and tranquility for nature to work its way - and the midwife can transfer to hospital if needed. Furthermore, the best international research shows that planned home births are less costly due to the lower rate of interventions.

In their conclusion the researchers therefore emphasize that doctors and midwives more actively should inform pregnant women about what the evidence about advantages and disadvantages of planning birth at home and hospital. They also emphasize that politicians and administrators should plan the birth care so that women and children have the best possible birth process.

Ref.: Olsen O, Clausen JA. Planned hospital birth compared with planned home birth for pregnant women at low risk of complications. Cochrane Database Syst Rev, 08 March 2023.

Read the full study at cochranelibrary.