Home Births Tied to Higher Infant Death Rates
Analysis of midwife-assisted deliveries suggests non-hospital setting, rather than practitioner type, is key factor
Another expert challenged the study's findings.
Melissa Cheyney, a midwife and associate professor of medical anthropology at Oregon State University, said the study data was unreliable. "For low-risk women, birth at home with a skilled midwife is a safe option that also confers many health benefits for mother and newborn," she said.
Grunebaum countered, saying, "This isn't about midwives; it's about birth settings."
For the study, Grunebaum and his colleagues used CDC data on nearly 14 million births and deaths.
The researchers found that the absolute risk of a baby dying at birth or in the 28 days following delivery was 3.2 per 10,000 births when a midwife delivered the baby in a hospital, compared with 12.6 per 10,000 births when a midwife delivered the baby at home.
Moreover, if the home delivery was the mother's first, the risk increased to 21.9 deaths per 10,000 births, the researchers found.
Each year, 18 or 19 more babies die during home deliveries than should, Grunebaum's team said. With the increase in popularity of home delivery, the number of excess deaths could reach nearly 32 a year by 2016, they said.
Cheyney, however, said there are significant problems with using this data to study outcomes by place of birth.
"For example, U.S. birth certificates do not reliably track intended place of birth," she said. "This means that between 10 percent and 25 percent of women who intended to deliver at home, but who transferred to the hospital during labor, have their outcomes erroneously recorded as hospital deliveries."
"It is unreliable and potentially misleading to compare groups when such a high percentage of your sample cannot accurately be assigned to one group or another," Cheyney said.
Although the study found a higher risk of infant death with home births, it did not establish a cause-and-effect relationship.