Study confirms home births result in avoidable adverse outcomes
A retrospective population-based cohort study found that risk factors such as breech presentation, twin delivery and previous cesarean section increased the likelihood of adverse neonatal outcomes in planned home births.
“There has been an increased interest in home births, and we were interested to understand differences in outcomes between home births and hospital births so those interested in home birth can be counseled adequately,” Amos Grünebaum, MD, a professor of obstetrics and gynecology at Zucker School of Medicine at Hofstra/Northwell in Uniondale, New York, and director of perinatal research at Lenox Hill Hospital in New York City, told Healio. “In addition, a recent publication in Obstetrics & Gynecology claimed that home births were safe, but that publication excluded actual [high-risk] patients who had worse outcomes. This provides an incomplete picture of outcomes.”
Grünebaum and colleagues reviewed 153,123 planned home births between 2016 and 2020 that were recorded in the CDC WONDER online natality database. The researchers compared these home birth outcomes with and without certain risk factors, including breech presentation, twin delivery, previous cesarean section, postmature delivery and nulliparity, combined with at least one of the following risk factors: diabetes, hypertension, eclampsia, previous premature births, pregnancies that resulted from infertility treatment and previous cesarean section.
Results showed any risk factor increased the likelihood of adverse outcomes, which included a 5-minute Apgar score of 3 or less, infant mortality, infant seizure and infant transfer. The highest risk for adverse outcomes occurred with breech presentation (OR = 8.88; 95% CI, 7.7-10.3) and twin delivery (OR = 2.8; 95% CI, 2.2-3.4).
Notably, breech presentation was significantly associated with a low 5-minute Apgar score (OR = 16.1; 95% CI, 12.1-21.4), infant mortality (OR = 14.12; 95% CI, 9.7-20.5) and infant seizure (OR = 16.16; 95% CI, 8.6-20.3).
The researchers said their findings were in line with previous research.
“[For] women asking where it’s safest to have a baby in the U.S., clinicians should tell them that newborns are at increased risks when born at home and that a hospital birth is the safest way for a newborn to be delivered,” Grünebaum told Healio.
“Future research should include why U.S. midwives are not adequately trained, why they are able to deliver babies without adequate guidelines for home births and why they refuse to have liability insurance,” he added.
References:
- Grünebaum A, et al. Am J Obstet Gynecol. 2021;doi:10.1016/j.ajog.2021.11.1347.
- Nethery, E, et al. Obstet Gynecol. 2021;doi:10.1097/AOG.0000000000004578.