MedPage Today: Risks of Infant Death Higher in Home Births for First-Time Moms

by Molly Walker on January 30, 2017

LAS VEGAS -- Planned home birth was associated with increased risk of complications, compared with hospital births, in women who had never have given birth before and in those with gestation extending to 41 weeks or beyond, according to a study reported here.

These risk factors were particularly pronounced among nulliparous women at more than 41 weeks gestation, who had the highest neonatal death rates after home births attended by midwives compared to hospital births attended by midwives (24.24 versus 5.09 neonatal deaths per 10,000 deliveries), reported Amos Grünebaum, MD, of Weill Cornell Medicine in New York City.

Planned home births were also linked with an overall higher neonatal death rate than hospital births (9.35 versus 3.39 neonatal deaths per 10,000 deliveries), according to the presentation at the Society for Maternal-Fetal Medicine annual meeting.

Joanne Stone, MD, of Mount Sinai Hospital, told MedPage Today that she was also working on research related to this topic, and had found that a lot of people who should not be considered candidates for home birth are attempting home birth.

"Certain people are really at risk for adverse outcomes, especially those with prior caesarean section, and they are really putting themselves at even greater risk," said Stone, who was not involved with Grünebaum's research. "We have to be very careful in terms of candidates for home birth and try to stick to that."

Grünebaum and colleagues performed a population-based retrospective cohort study of non-anomalous births in singleton pregnancies of at least 37 weeks gestational age, using 2003 CDC revised birth certificate data and data from CDC's linked birth-death infant files, which allowed for the identification of unattended home births. Overall, there were 75,065 home births and over 1 million hospital births included in the study.

The American College of Obstetricians and Gynecologists currently lists three "absolute contraindications" for planned home birth: prior caesarean delivery, fetal malpresentation and multiple gestation. But Grünebaum and colleagues found markedly increased neonatal mortality risk for home versus hospital births in connection with these other factors :

  • Nulliparity (17.25 at home versus 4.16 in hospital per 10,000 deliveries)
  • ≥41 weeks gestation (13.14 versus 4.38 per 10,000 deliveries)
  • ≥35 years maternal age (10.61 versus 3.17 per 10,000 deliveries)

 

Grünebaum and his team have done extensive research comparing home birth and hospital birth. He recently published a study that found "labor and delivery" causes were associated with 39% of neonatal deaths in neonatal home births attended by midwives, with 29.5% due to congenital anomalies and 12.3% due to infections.

"Women want to deliver at home with the thought that hospitals are dirty and filthy and infect their babies, but when you look at neonatal death, infection is one of the main causes," said Grünebaum.

He argued at the presentation not only that patients considering a planned home birth should be informed about the "increasing risks and contraindications" of home birth, but that hospitals should limit interventions and provide options for women desiring more home birth-like settings.

Grünebaum cited a recent ACOG committee opinion that argued that clinicians consider fewer interventions during hospital deliveries in low-risk patients. In addition, he said that clinicians should "offer and encourage" trial of labor after caesarean.

He concluded that nulliparity and 41-plus weeks of gestation should be made contraindications for home birth.

Stone told MedPage Today that she thought this was something that should "definitely be considered," but added that she would like to see these data validated in another study.

The authors disclosed no relevant financial relationships.

This article was published first by MedPageToday Risks of Infant Death Higher in Home Births for First-Time Moms, a trusted and reliable source for clinical and policy coverage, and free Continuing Medical Education (CME), that directly affects the lives and practices of health care professionals.

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