ACOG emphasizes hospital use for birth safety, expands home birth contraindications

Women who are considering giving birth at home should be informed about potential risks and benefits based on recent evidence and guidelines, according to a committee opinion issued by The American College of Obstetrics and Gynecologists.

Approximately 35,000 births occur in homes each year, accounting for 0.9% of all U.S. births, the organization noted, and 25% of these births are unplanned or unattended.

In its statement, ACOG emphasized its belief that hospitals and accredited birth centers are the "safest setting" for birth, but acknowledged that all women have the right to "make a medically informed decision about delivery."

"Obstetrician-gynecologists recognize that women are seeking home births for a variety of reasons," Joseph R. Wax, MD, an author of the opinion, said in the release. "Our goal is to help them understand and balance the benefits with the risks by providing information to help them come to a medically informed decision."

ACOG included additional evidence in its updated opinion, including the increased risk for perinatal death in home settings. The opinion notes that while home birth is associated with fewer maternal interventions, it is also associated with "a more than twofold increased risk of perinatal death and a threefold increased risk of neonatal seizures or serious neurologic dysfunction."

ACOG urged obstetrician-gynecologists to advise women of home birth risks, even in cases of uncomplicated pregnancy.

The organization underscored the importance of provider type when choosing a home birth and recommended that women select "a certified nurse-midwife, certified midwife, or a midwife whose education and licensure meet International Confederation of Midwives Global Standards, or a physician practicing obstetrics within an integrated and regulated health system."

Other factors that impact home birth outcomes include access to consultation throughout pregnancy and access to prompt and safe transport to a nearby hospital if needed.

The organization reported that 23% to 37% of women who are delivering their first child ultimately need transport to an obstetric facility due to "lack of progress in labor, nonreassuring fetal status, need for pain relief, hypertension, bleeding and fetal malposition."

ACOG also expanded its list of absolute contraindications for home birth to include multiple gestation, fetal malpresentation and prior cesarean delivery.

"Although serious complications are rare, they may be serious and unpredictable," Wax said. "It's important for women to be able to choose the birth setting that is right for them. As part of this decision making, women should be aware of the contraindications to home birth as well as factors associated with reduced perinatal mortality." – by Chelsea Frajerman Pardes