Less Medical Intervention for Home Birth Linked to Increased Neonatal Mortality Rate

Laurie Barclay, MD

July 02, 2010

July 2, 2010 — Less medical intervention during planned home birth is associated with a tripling of the neonatal mortality rate vs planned hospital birth, according to the results of a systematic review and meta-analysis reported online first July 1 and will appear in the September 10 print issue of the American Journal of Obstetrics & Gynecology.

"The American College of Obstetricians and Gynecologists does not support home birth, citing safety concerns and lack of rigorous scientific study," write Joseph R. Wax, MD, from Maine Medical Center in Portland, and colleagues. "We sought to systematically review the medical literature on the maternal and newborn safety of planned home vs planned hospital birth."

Selection criteria for the meta-analysis were English-language peer-reviewed publications from developed Western nations, in which maternal and newborn outcomes were reported by planned delivery location. The investigators calculated summary odds ratios with 95% confidence intervals for these outcomes.

Compared with planned hospital births, fewer maternal interventions were associated with planned home births, including epidural analgesia, electronic fetal heart rate monitoring, episiotomy, and operative delivery. Women who delivered at home had lower rates of lacerations, hemorrhage, and infections, and their offspring had lower rates of prematurity, low birth weight, and assisted newborn ventilation.

Perinatal mortality rates were similar for planned home and hospital births, but neonatal mortality rates were significantly higher with planned home births.

"Less medical intervention during planned home birth is associated with a tripling of the neonatal mortality rate," the study authors write.

Limitations of this study include those inherent in the included studies, self-selection of women for home birth, and insufficient data for some outcomes.

"Future research needs to be directed at identifying contributors to and reducing the apparently excessive neonatal mortality among planned home births," the study authors conclude. "Data regarding maternal mortality, maternal and newborn readmission rates and indications, and newborn neurologic injury are insufficient for evaluation and comparison.... Ideally, the results of such work will contribute to an obstetric and newborn best practices model benefiting women and children regardless of chosen birth location."

The study authors have disclosed no relevant financial relationships.

Am J Obstet Gynecol. Published online July 1, 2010.

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