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Risk for perinatal mortality lower for hospital births vs. in-home births
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Planned hospital birth was associated with a lower risk for infant death and other complicating factors when compared with in-home birth, according to recent research in the New England Journal of Medicine.
“Using data from Oregon birth certificates, we showed that the rates of obstetrical interventions were lower but the risks of perinatal death and other adverse neonatal outcomes were higher with planned out-of-hospital birth than with planned in-hospital birth,” Jonathan M. Snowden, PhD, of the departments of obstetrics and gynecology at Oregon Health and Science University, and colleagues wrote. “However, the absolute differences in the risks of adverse neonatal outcomes were small.”
In a retrospective, cohort study, the researchers analyzed birth certificate data from all births in Oregon during 2012 and 2013. Information related to planned place of birth, high-risk conditions and demographics were extracted from participants’ birth certificates. The researchers excluded unplanned home births, multiple births, preterm births and births with other complicating factors from the study. Primary outcomes included perinatal morbidity and mortality, maternal morbidity and obstetrical procedures.
Overall, Snowden and colleagues studied 75,923 hospital births, 1,968 home births and 1,235 birth-center deliveries.
Study results showed that planned home birth was associated with a perinatal death rate of 3.9 per 1,000 births, compared with 1.8 per 1,000 planned in-hospital births (adjusted OR = 2.43; 95% CI, 1.37-4.3). Planned in-hospital birth was associated with a lower rate of neonatal seizures (P = .02), but a higher rate of NICU admissions (P < .001), compared with in-home birth. In-home birth was associated with an increase in unassisted vaginal delivery (93.8% vs. 71.9%; P < .001) and decreased likelihood of obstetrical procedures (P < .001).
“Serious adverse fetal and neonatal outcomes are infrequent in all the birth settings we assessed, and the absolute differences in risk that we observed between planned birth locations were correspondingly small,” Snowden and colleagues wrote.
In a related editorial, Michael F. Greene, MD, and Jeffrey L. Ecker, MD, both of the department of obstetrics and gynecology at Massachusetts General Hospital, commented on the importance of Snowden and colleagues’ findings.
“The present data empower women to make rational decisions about their choices regarding planned place of delivery,” Greene and Ecker wrote. “Women who plan out-of-hospital birth to avoid obstetrical interventions now have important information on the associated rates of perinatal complications, and those who choose hospital birth to minimize their risks of perinatal complications now have a better idea of the magnitude of the actual reduction in risk. Ultimately, women’s choices for place of delivery will be determined by the extent of their tolerance for risk and which risks they most want to avoid.” – by David Costill
Disclosure: The researchers report no relevant financial disclosures. Ecker reports employment as an associate editor of the New England Journal of Medicine.
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