July 2, 2010 — Planned home births are associated with a tripling of the newborn mortality rate compared with planned hospital deliveries, yet planned home births are also linked to reduced preterm birth and low birth weight, according to a new study.
Research conducted by Joseph R. Wax, MD, and colleagues, from the department of obstetrics and gynecology at Maine Medical Center in Portland, shows that the overall newborn death rate was almost twice as high in planned home vs. planned hospital births, and was almost tripled among those newborns in planned home births without any congenital abnormalities.
Although rare, newborn deaths occurred in 0.2% of the total planned home births included in the analysis, compared with 0.09% of the total planned hospital births. Among infants born without any birth defects, the rates were 0.15% vs. 0.04%, respectively.
Overall, compared with hospital deliveries, planned home births were associated with reduced medical intervention for the mothers and in reduced prematurity and low birth weight, the researchers reported. However, planned home births were also linked to neonatal deaths attributed to respiratory distress and failed resuscitation.
Fewer Complications for Mothers Having Home Births
The findings, published online by the American Journal of Obstetrics & Gynecology, are based on an analysis of international data. The data included maternal and newborn outcomes for planned and home births recorded in national registries and birth certificates in industrialized, Western countries. Wax and his team included data for a total of 342,056 planned home births and 207,511 planned hospital deliveries. They looked at both the health of the infants and of the mothers.
They found that there was no overall difference in newborn assisted ventilation between home and hospital deliveries. Women who participated in planned home births had lower obstetric risk factors overall, including lower rates of obesity, previous cesarean sections, or previous pregnancy complications.
Researchers also reported that women who participated in planned home births had:
- Less use of epidurals and episiotomies
- Fewer infections and perineal or vaginal lacerations
- Less hemorrhaging or incidences of retained placentas
- Fewer operative deliveries, such as cesareans
“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,” Wax and colleagues write. “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.”
Group Discourages Home Births
Home birth is a controversial topic, and questions over safety are at the heart of the issue. The American College of Obstetricians and Gynecologists, one of the largest professional ob-gyn organizations in the U.S., does not support planned home births because of safety concerns and a lack of scientific evidence. Every year, about 25,000 women in the United States (or 1 in 200) deliver at home, and about 75% of these are low-risk, single-baby births that are planned to be a home delivery.
The editors-in-chief of the American Journal of Obstetrics and Gynecology, Thomas J. Garite, MD, and Moon H. Kim, MD, comment 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.”
Experts Weigh In
Kimberly D. Gregory, MD, MPH, vice chair of women’s healthcare quality and performance improvement, department of obstetrics and gynecology at Cedars-Sinai Medical Center in Los Angeles, says the findings will have little impact on the rate of home births.
“Those women who are truly motivated are going to do it despite the odds, and most will do well and have a good outcome. It would be great if women (and clinicians) could take this message as evidence to encourage more ‘natural’ management of the birth process in a hospital where resources would be available if needed in an emergency.”
Mary Lawlor, CPM, LM, president of the National Association of Certified Professional Midwives, says there is also evidence supporting the safety of planned home births.
“There is a body of international research that confirms that home birth is a safe option for well-screened women experiencing a low-risk pregnancy who choose this option, when they are cared for by trained, qualified attendants, with access to emergency services when needed,” Lawlor tells WebMD.