Department of Obstetrics and Gynecology, University Hospital Germans Trias i Pujol, Badalona, Spain; Research Group on Sexual and Reproductive Healthcare (GRASSIR) (2021-SGR-01489), Barcelona 08007, Spain; Catalan Association of home birth Midwives, Barcelona, Spain; Sexual and Reproductive Healthcare, Catalan Health Institute, Spain.
Head of the Affective, Sexual and Reproductive Health Plan of the Ministry of Health, Government of Catalonia, Spain; Global Health, Gender and Society Research Group, Facultat de Ciències de la Salut Blanquerna, Universitat Ramon Llull, Barcelona, Spain.
Midwifery. 2024 Sep;136:104101. doi: 10.1016/j.midw.2024.104101. Epub 2024 Jul 6.
The debate on the safety and outcomes of home versus hospital births highlights the need for evidence-based evaluations of these birthing settings, particularly in Catalonia where both options are available.
To compare sociodemographic characteristics and maternal and neonatal outcomes between low-risk women opting for home versus hospital births in Catalonia, Spain.
This observational cross-sectional study analysed 3,463 low-risk births between 2016 and 2018, including 2,713 hospital and 750 home births. Researchers collected sociodemographic data, birthing processes, and outcomes, using statistical analysis to explore differences between the settings.
Notable differences emerged: Women choosing home births typically had higher education levels and were predominantly Spanish. They were 3.43 times more likely to have a spontaneous birth and significantly less likely to undergo instrumental births than those in hospitals. Home births were associated with higher utilization of non-pharmacological analgesia and a more pronounced tendency to iniciate breastfeeding within the first hour post birth and stronger inclination towards breastfeeding. Hospital births, conversely, showed higher use of the lithotomy position and epidural analgesia. There were no significant differences in neonatal outcomes between the two groups.
Home births managed by midwives offered better obstetric and neonatal outcomes for low-risk women than hospital births. These results suggest home birth as a safe, viable option that promotes natural birthing processes and reduces medical interventions. The study supports the integration of midwife-led home birth into public health policies, affirming its benefits for maternal and neonatal health.
家庭分娩与医院分娩的安全性和结果的争论凸显了对这些分娩环境进行基于证据的评估的必要性，特别是在提供这两种分娩选择的加泰罗尼亚地区。
比较在西班牙加泰罗尼亚选择家庭分娩与医院分娩的低风险妇女的社会人口学特征以及母婴结局。
本观察性横断面研究分析了 2016 年至 2018 年期间的 3463 例低风险分娩，包括 2713 例医院分娩和 750 例家庭分娩。研究人员收集了社会人口学数据、分娩过程和结局，并使用统计分析方法探讨了这两种环境之间的差异。
出现了显著差异：选择家庭分娩的妇女通常具有更高的教育水平，主要是西班牙裔。她们自然分娩的可能性是在医院分娩的妇女的 3.43 倍，而使用器械分娩的可能性显著降低。家庭分娩与更高的非药物性镇痛使用率以及在出生后第一小时内更明显的开始母乳喂养的倾向以及更强的母乳喂养倾向相关。相比之下，医院分娩显示出更高的截石位和硬膜外镇痛使用率。两组新生儿结局无显著差异。
由助产士管理的家庭分娩为低风险妇女提供了更好的产科和新生儿结局，优于医院分娩。这些结果表明家庭分娩是一种安全可行的选择，可促进自然分娩过程并减少医疗干预。该研究支持将助产士主导的家庭分娩纳入公共卫生政策，肯定其对母婴健康的益处。
