© 2010 Roy Benaroch, MD
Thinking of having your baby’s delivery at home? You might want to think again.
Each year in the United States about 25,000 babies are delivered at home; 75% of these are planned, low-risk births (presumably the rest are panicked moments that make good stories later.). Researchers recently published a study pooling data from multiple worldwide reports comparing health outcomes of 342,056 planned home deliveries versus 207,511 hospital births in industrialized, western countries.
The good news for proponents of home delivery: overall, the women giving birth had fewer episiotomies, fewer c-sections, and less-invasive obstetric monitoring. They were also less likelye to develop post-partum infections and hemorrhage.
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However, there is a price: the neonatal mortality overall was doubled among babies born at home. In fact, three times as many died if you exclude babies with known congenital defects (many of whom would not be resuscitated whether at home or in the hospital). The overall death rate at home was 0.2%, versus 0.09% in the hospital, even though home babies were certainly far less “high risk” to begin with.
The data wasn’t collected in a way that allowed the authors to more specifically identify risk factors for poor neonatal outcome. There are several, well-established “high risk” criteria that already preclude home birth: prematurity, maternal health risks, obesity, prior c-section, or not having a hospital nearby for transport in case of emergencies. There may be other risk factors that are less well known. But I’m sure that at least some of these babies who died had no risk factors at all.
National organizations representing nurse-midwives have criticized the study and its conclusion, claiming that they used too much older data and too many studies that poorly differentiated planned from unplanned home births. However, the sheer size of this study dwarfs all previous reports, and I think it is difficult to imagine that such a big difference is only the result of how and when the data was collected.
The vast majority of planned, low-risk home births will be successful, and chances are you’ll get yourself a happy and healthy baby whether the birth is at home or in a hospital. But the chances are better in a hospital, where if things go wrong high-tech intervention to help a mother or baby is available. Not all emergencies can be planned or expected. Staying home is a chance you might not want to take.