Home Births Four Times as Risky US Researchers Warn
Babies are four times more likely to die being delivered at home than they are in hospital, according to new research.
Study authors said expectant parents should be warned about the risks of giving birth at home, saying they warned “strongly against it”.
The study shows that patients delivered at home by midwives had a roughly four times higher risk of neonatal deaths than babies delivered in the hospital by midwives.
Study author Doctor Amos Grunebaum said: “This risk further increased to about seven-fold if this was the mother’s first pregnancy, and to about ten-fold in pregnancies beyond 41 weeks.”
In the largest study of its kind, looking at nearly 14 million linked infant birth and neonatal death data, it found the absolute risk of neonatal mortality was 3.2/10,000 births in midwife hospital births, and 12.6/10,000 births in midwife home births.
Researchers at New York-Presbyterian Weill Cornell Medical Centre found the risks further increased in first-time mothers, to 21.9/10,000 births in midwife home deliveries.
Experts in this country said the findings should be considered closely after they are published, but said that maternity systems worked differently in this country, with higher levels of training for midwives.
Dr Grunebaum and Frank Doctor Chervenak, the main authors of the study, said that obstetric practitioners have an ethical obligation to disclose the increased absolute and relative risks associated with planned home birth to expectant parents who express an interest in this delivery setting, and to recommend strongly against it.
The authors also said hospitals should create a welcoming and comfortable birthing environment, as well as address unnecessary obstetric interventions, both of which are often a primary motivation for planned homebirth.
In the study, which is due to be presented at the Society for Maternal-Foetal Medicine’s annual meeting in New Orleans later this week, neonatal mortality was defined as deaths up to 28 days after delivery.
The most recent homebirth statistics from BirthChoice UK, show that off all births in 2011 (680,565) 16,090 were delivered at home, and compared to the homebirth peak in 2008, it was down 15 per cent.
Previous research in this country has suggested that women who have second or third babies were just as safe giving birth at home or in a midwife-only unit as they were in a hospital unit, but have warned of higher risk for those having their first child.
Oxford University researchers examined more than 65,500 births classified as low risk.
They found that rates of complications affecting the baby including stillbirth after the start of labour, the baby dying within the first week of birth, brain injury, fractures to the upper arm or shoulder during birth, and faeces in the lungs, were higher for first time mothers.
There were 9.5 such complications per 1,000 births for first time mothers having their baby at home, compared with 3.5 per 1,000 births to first time mothers in hospital.
There was no increased risk for babies whose birth was planned at units led by midwives, either ones that stand alone in the community or which are attached to a hospital, according to the report, published in the British Medical Journal.
The researchers stressed that giving birth is generally very safe as 250 babies suffered complications from the 64,538 births in the study.
Cathy Warwick, chief executive of the Royal College of Midwives, said: “Findings from UK studies of home birth do not concur with this study’s findings.
"Oxford University Birthplace Study of 2011 showed that planned out of hospital births were, generally, as safe for the baby as those in hospital for low-risk women having their second or subsequent baby."
She added: "International comparisons of homebirth outcomes are very difficult, almost impossible, between America and England due to the different healthcare systems and contexts.”
Laura Donnelly - telegraph.co.uk
