Home birth: Is there added risk?

The Pediatric Insider

© 2010 Roy Benaroch, MD

Thinking of having your baby’s delivery at home? You might want to think again.

Each year in the United States about 25,000 babies are delivered at home; 75% of these are planned, low-risk births (presumably the rest are panicked moments that make good stories later.) Researchers recently published a study pooling data from multiple worldwide reports comparing health outcomes of 342,056 planned home deliveries versus 207,511 hospital births in industrialized, western countries.

The good news for proponents of home delivery: overall the women giving birth had fewer episiotomies, fewer c-sections, and less-invasive obstetric monitoring. They were also less likelye to develop post-partum infections and hemorrhage.

However, there is a price: the neonatal mortality overall was doubled among babies born at home. In fact, three times as many died if you exclude babies with known congenital defects (many of whom would not be resuscitated whether at home or in the hospital.) The overall death rate at home was 0.2%, versus 0.09% in the hospital, even though home babies were certainly far less “high risk” to begin with.

The data wasn’t collected in a way that allowed the authors to more-specifically identify risk factors for poor neonatal outcome. There are several, well-established “high risk” criteria that already preclude home birth: prematurity, maternal health risks, obesity, prior c-section, or not having a hospital nearby for transport in case of emergencies. There may be other risk factors that are less well known. But I’m sure that at least some of these babies who died had no risk factors at all.

National organizations representing nurse-midwives have criticized the study and its conclusion, claiming that they used too much older data and too many studies that poorly differentiated planned from unplanned home births. However, the sheer size of this study dwarfs all previous reports, and I think it is difficult to imaging that such a big difference is only the result of how and when the data was collected.

The vast majority of planned, low-risk home births will be successful, and chances are you’ll get yourself a happy and healthy baby whether the birth is at home or in a hospital. But the chances are better in a hospital, where if things go wrong high-tech intervention to help a mother or baby is available. Not all emergencies can be planned or expected. Staying home is a chance you might not want to take.

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3 Comments on “Home birth: Is there added risk?”

  1. Russ Fawcett Says:

    Roy,

    It is quite disappointing that such junk science would sprout legs and walk around the news media and the blogosphere. The only thing that Wax, et. al. did was to breath new life into old flawed studies that have been widely criticized on their technical merit. If you want to study outcomes of planned home birth, it is imperative that you be able to differentiate between 1) planned home birth that is attended by a trained midwife, 2) planned but unattended home birth and 3) unplanned and unattended home birth. If you do nothing else, you must assure quality control over this as these attributes are key in understanding outcomes. The studies that Wax, et. al. selected to base their conclusions on neonatal mortality rates (conclusions that were established a priori) could not make the distinction (even though Wax, et. al. clearly tried to hide which studies were used in estimating neonatal mortality rates).

    Here are more than a few criticisms of this paper in the National Childbirth Trust’s critique of Wax Paper:

    http://www.nct.org.uk/about-us/what-we-do/policy/choiceofplaceofbirth

    I am now going to play the integrity card. It is clear that the authors knew exactly what they were doing in light of legislative initiatives seeking to expand access to home birth midwives along with accelerating rates of planned home birth. Their technical records should be audited and this study should be withdrawn from publication except for how this illustrates how bias, and entrenched opposition, can influence the development of scientific literature.

    Russ

    Russ Fawcett
    Vice President, North Carolina Friends of Midwives

    Like

  2. Dr. Roy Says:

    I don’t know about sprouting legs and walking around, but I appreciate the reply and link to the opposing view.

    Like

  3. david michel Says:

    people are stupid

    Like


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