Home Births Are Riskier, But Perinatal Death Is Still Rare

Woman in labor before childbirth

After taking into account the differences between women who opt for a hospital birth and women who prefer a less medicalized setting, researchers calculated that there were 1.52 additional deaths per 1,000 births when the deliveries were planned for homes or birthing centers instead of hospitals.

Around 80,000 pregnancies were analyzed during the study, and it was found that the baby's born out of the hospital or in birthing centers displayed increased probability of death and complicated risks, especially during the first month or birth process.

This data set allowed researchers for the first time to separate women who planned out-of-hospital births but were transferred to the hospital due to heightening risks.

In the United States, births not in a hospital are still extremely rare, accounting for fewer than 1 percent of births, according to the American College of Obstetricians and Gynecologists. That means, there is a 2.43 times greater risk that a baby born at home or in a birthing center will die before it's delivered or within 28 days after birth.

In addition, women trying to give birth at home tended to lack health insurance, so the decision to have a home birth, and to transfer to hospital if a problem looms "may be determined in part by financial ability, rather than suitability to giving birth in an out-of-hospital setting", she said. But study's findings have shown that home births have been on the rise, and it has been hard to assess how safe it is, because the numbers get conflated in confusing ways.

It quoted Dr. Michael Greene, chief of obstetrics at Massachusetts General Hospital and an associate editor of The New England Journal of Medicine, as saying the question is what is most important to the women and what risks they are willing to accept. Rest of the out-of-hospital births took place at home.

To get a clearer picture of the comparative risks, a team led by epidemiologist Jonathan Snowden of Oregon Health & Science University examined all births in the state in 2012 and 2013. "The tradeoff is, in the hospital, you lose control over your birth experience".

"There is now consensus in the medical and midwifery communities that the U.S. C-section rate is too high, and the desire to avoid a C-section may shape women's choices when seeking out-of-hospital birth", said Ellen Tilden, Ph.D., C.N.M., assistant professor at OHSU School of Nursing and study co-author.

"With this change came the "medicalization" of birth, as hospitals introduced interventions to reduce the risks inherent to childbirth that could not be performed in the home setting", the editorial said. But in any location the overall risk to the child is very low, the study showed.

They excluded births involving twins, birth defects, breech or premature delivery. "It's really important that we strive to make birth safer in any setting, both through decreasing fetal and neonatal morbidity and mortality out of the hospital but also through supporting safe vaginal birth in hospitals". "This study underscores the importance of that being a truly informed choice".

Nationally there has been a significant increase in the rate of home births. Now, Oregon scientists and health workers who deliver babies have some research evidence that sheds a bit more light. "Also if we could have formal, mutually agreed upon, in-writing agreements between out-of-hospital providers and in-hospital providers, that would enable a more seamless transition of care from the out-of-hospital setting to in-hospital setting".

NPR report said, how safe is it in the United States to be born someplace other than a hospital? "That's the slippery slope, if we don't figure out ways to embrace women's preferences and doing things that women are comfortable with".

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