Community births increase during COVID-19 pandemic — so do risks

Community births — at home or at freestanding birth centers — increased during the COVID-19 pandemic, researchers reported.

This meant that the risks associated with births outside the hospital setting increased as well, they said.

“The COVID-19 pandemic has affected nearly every aspect of our lives, including changes in women's perception of where it's safest to deliver the baby,” 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. “Hospitals needed to implement restrictions to labor and delivery units to prevent COVID-19 infections, and women thought it's safer to deliver at home.”

Grünebaum and colleagues used data from 3,747,540 births in 2019 and 3,613,647 in 2020 available through the CDC WONDER online natality database to compare the number of home births, hospital births and births at freestanding birth centers. They also determined differences in risk profiles between 2019 and 2020.

Hospital births by midwives and by other professionals decreased by 0.2% and 4.3%, respectively; risk profiles decreased among hospital births, although this corresponded with the overall decrease in births, the researchers wrote in the American Journal of Obstetrics & Gynecology.

Conversely, planned home births and births at birth centers increased by 20.2% and 9.2%, respectively, with nonhospital births peaking in May 2020, plateauing and then dropping in October 2020.

“What was surprising is that there was an unexpected further rise in risky births like breech and twins among out-of-hospital births,” Grünebaum told Healio. “Risky out-of-hospital births lead to an increase in neonatal morbidity and mortality, and we showed an increase in low 5-minute Apgar score of 0-3, which may be one of the first indicators of neonatal brain damage.”

Additionally, there was an increase in the number of women with previous cesarean section, from 1 in 23 women in 2019 to 1 in 21 in 2020, the researchers wrote.

“During the COVID-19 pandemic, it was argued that community births offered improved safety compared with hospital births,” Grünebaum and colleagues wrote. “However, our data showed a different result.”

Moving forward, Grünebaum said stricter guidelines for home births should be enacted to mitigate risks.

“Presently, most home births in the U.S. are done by midwives without liability insurance, so when there are adverse outcomes, patients are left without adequate compensation,” he told Healio. “Patients also need to be fully informed of potential home birth complications, that transfers to the hospital cannot guarantee safety and that home birth midwives have no liability insurance.”