Home birth not as safe, cost effective or satisfying as previously reported

Home birth not as safe, cost effective or satisfying as previously reported

Having a home-birth- similar experience in the hospital proves to be more financially feasible, safer, and more satisfying than an actual at home birth, according to new research appearing in the American Journal of Obstetrics & Gynecology.

Advocates of planned home birth have stressed its advantages for patient safety, low costs, respect for women's choices, and patient satisfaction. This new study closely examines each of these suggestions in an effort to pinpoint proper responses for health professionals who are concerned with planned home birth.

In recent years, planned home birth has risen in popularity throughout Europe and the United States.

Lead author Frank A. Chervenak, MD, the Given Foundation Professor and chairman of the Department of Obstetrics and Gynecology at Weill Cornell Medical College, and obstetrician and gynecologist-in-chief and director of maternal-fetal medicine at New York-Presbyterian Hospital/Weill Cornell Medical Center, said:

"Positions taken about planned home birth, in our view, are not compatible with professional responsibility for patients....We call on obstetricians, other concerned physicians, midwives, and other obstetric providers, and their professional associations not to support planned home birth when there are safe and compassionate hospital-based alternatives and to advocate for a safe home-birth-like experience in the hospital."

The authors analyzed evidence of obstetric results and found that planned home birth does not meet safety standards for patients presently. During home birth, surprise complications can develop during labor and can lead to late emergency treatment. When travel is required from home to an obstetric unit, the perinatal mortality rate was documented to be over eight times greater than without this transport.

Patient satisfaction is often reported as one of the main advantages of home birth, however, the researchers of this study found this satisfaction was weakened by a high incidence of mandatory emergency transport as well as delayed emergency care.

Other factors that compromised patient satisfaction were pain levels of the patient, anxiety about losing the baby during transport, and unhappiness with caregivers. Physicians and their staff can produce a home-birth-like environment in the hospital which can guarantee patient satisfaction and appropriate healthcare personnel.

On the topic of cost effectiveness, the authors cite a study that reports an increase in costs for home births that is three times greater; expenses include obstetrician services, a midwife, and patient transport. Examination of costs must also take into account:

  • professional liability
  • transport system maintenance
  • hospital admission
  • lifetime expenses of supporting neurologically disabled children
Lastly, the authors analyzed the relationship between women's rights and home birth. Their findings suggest that medical professionals should not let the unlimited rights of pregnant women dictate the location of the birth. They believe this would be unethical.

After examination of these four different claims, the researchers were able to develop appropriate responses to obstetricians' questions in reference to their responsibility for planned home birth. These topics include:

  • root cause of planned home birth recrudescence
  • responding to patients who ask about or request home birth
  • receiving a patient on emergency transport from planned home birth
  • planned home birth clinical trials
Professional associations of obstetricians have a responsibility to encourage patient safety, and reevaluate their statements on planned home birth, shifting them to agree with professional responsibility.

Dr. Chervenak concludes:

"Advocacy of planned home birth is a compelling example of what happens when ideology replaces professionally disciplined clinical judgment and policy. We urge obstetricians, other concerned physicians, midwives and other obstetric providers, and their professional associations to eschew rights-based reductionism in the ethics of planned home birth and replace rights-based reductionism with an ethics based professional responsibility."

The argument over hospital birth versus at home birth will continue. These authors' findings oppose findings from a previous review this year, stating that home birth is actually a realistic and safe option with less interventions and complications than hospital birth.

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Section Issues On Medicine: Women health