Home Births Linked to Higher Newborn Death Rate
Planned Home Births Also Associated With Reduced Medical Intervention for Moms
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.”