Risks of Planned Home Births Greatly Outweigh the Benefits

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Researchers from the Maine Medical Center in Portland have found several benefits linked to planned home deliveries, but the risk of newborn mortality greatly outweighs the positives of giving birth at home.

Joseph R. Was MD and colleagues from the department of obstetrics and gynecology found that planned home births were liked with lower rates of medical interventions, such as epidurals and episiotomies, fewer infections and perineal or vaginal lacerations, and less hemorrhaging or incidences of retained placentas. They also found preterm birth and low birth weight were also reduced in home births.

However, because of respiratory distress and failed resuscitation attempts, the newborn mortality rate of babies born at home was triple that of babies born in a hospital, even in the absence of congenital abnormalities.

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The researchers analyzed data from 342,056 planned home births and 207,511 planned hospital births recorded in national registries and birth certificates in industrialized, Western countries. Newborn deaths occurred in 0.2% of home births and 0.09% of hospital births.

“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,” the researchers write. “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.”

Every year, about 25,000 women in the United States (about 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. According to a study published last year in the Journal of Midwifery and Women’s Health, most women who choose home births are married white women with a college education. Their reasons for wanting home birth include avoidance of unnecessary medical interventions, previous negative hospital experience, and more control during the birth experience.

The American College of Obstetricians and Gynecologists does not support planned home births because of safety concerns and lack of scientific evidence. The group acknowledges that the findings of this study, published online in the American Journal of Obstetrics & Gynecology, supports the safety of planned home birth for the mother, but raises serious concerns for the newborn infant.

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Comments

After further analysis of the data, it was shown that the risks were comparable in planned home vs. hospital birth. The analysis that showed a three fold risk included studies that did not differentiate between planned and unplanned home births, studies that were poorly designed, and studies that were nearly 40 years old.