Home births linked to significantly higher death rates for babies

Home births linked to significantly higher death rates for babies

Approximately 0.5% of US births occur at home, of which about three-quarters are low low-risk, single-baby births planned in advance as home deliveries. A study published in the peer-reviewed American Journal of Obstetrics & Gynecology (AJOG), researchers from Maine Medical Center, Portland, Maine, examined the results of multiple studies worldwide. They report that less medical intervention, characteristic of planned home births, is associated with a tripling of the neonatal mortality rate compared to planned hospital deliveries. Planned home births were associated with a higher number of deaths attributed to respiratory distress and failed resuscitation.

Lead investigator Joseph R. Wax, MD, Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, Maine Medical Center, said:

Our findings raise the question of a link between the increased neonatal mortality among planned home births and the decreased obstetric intervention in this group. Women choosing home birth, particularly low-risk individuals who had given birth previously, are in large part successful in achieving their goal of delivering with less morbidity and medical intervention than experienced during hospital-based childbirth. Of significant concern, these apparent benefits are associated with a doubling of the neonatal mortality rate overall and a near tripling among infants born without congenital defects (nonanomalous)....These findings echo concerns raised in a recent large US cohort study in which home births experienced significantly more 5-minute Apgar scores

The researchers carried out a rigorous meta-analysis through which the peer-reviewed medical literature was gleened for studies that contained data about home and hospital deliveries, including morbidity and mortality data for both mother and child. Information was extracted for a total of 342,056 planned home and 207,551 planned hospital deliveries. The results are surprising, because women planning home births were of similar and often lower obstetric risk than those planning hospital births.

In contrast to neonatal mortality rates, researchers found that perinatal (period immediately before and after birth) mortality rates for planned home and hospital births were similar overall, as well as just among nonanomalous offspring.

Mothers in planned home births experienced considerably fewer medical interventions including epidural analgesia, electronic fetal heart rate monitoring, episiotomy, and operative vaginal and cesarean deliveries. Similarly, women intending home deliveries had fewer infections, perineal and vaginal lacerations, hemorrhages, and retained placentas. Data also showed that planned home births are characterized by less frequent premature and low birthweight infants.

AJOG Editors-in- Chief Thomas J. Garite, MD, and Moon H. Kim, MD, commented that:

The report by Wax et al supports the safety of planned home birth for the mother, but raises serious concerns about increased risks of home birth for the newborn infant. This topic deserves more attention from public health officials at state and national levels.

"Maternal and newborn outcomes in planned home versus planned hospital birth - a metaanalysis "

Joseph Wax, F. Lee Lucas, Michael Pinette, Angelina Cartin, Jacquelyn Blackstone

American Journal of Obstetrics & Gynecology

Source: Elsevier

My Babies were Born at Home. Here's the Story. (Video Medical And Professional 2020).

Section Issues On Medicine: Women health