Planned home birth still carries risks

Although women who plan to give birth at home end up with fewer medical interventions during labor, their babies have a higher risk of death and seizure soon after birth, experts warn.

Hospitals and accredited birth centers are still the safest place for a woman to give birth, according to the American College of Obstetricians and Gynecologists (ACOG).

In a newly published Committee Opinion, the College describes times when home birth should not be considered, such as when the fetus is in a breech or transverse position rather than head-down, when the mother is pregnant with multiples or when she's had a Cesarean section in the past.

The last ACOG Opinion on this topic was published in 2011. Since then, a number of studies have cleared up some uncertainties about birth outcomes, particularly as home birth is practiced in the U.S., said primary author Dr. William H. Barth Jr., chief of the Division of Maternal-Fetal Medicine at Massachusetts General Hospital.

"For example," he told Reuters Health by email, "a large study of planned home birth versus planned hospital birth in Oregon, a state that probably leads others in the organization and reporting of planned home birth, has shown that planned home birth is associated with fewer labor inductions, fewer labor augmentations, fewer operative vaginal deliveries and importantly, significantly fewer cesarean deliveries."

"However, this and other more recent studies conducted in the U.S. confirm that planned home birth is also associated with higher rates of low Apgar scores, neonatal seizures or serious neurologic disorders and neonatal death," he said. "The absolute rates of these are low, but they are consistently higher with planned home birth."

Planned hospital births more often involve labor induction, Cesarean section, severe perineal lacerations and other complications compared to planned home birth. But babies born by planned home birth are twice as likely to die in the process and three times as likely to experience a seizure as those born in a hospital, according to the statement.

For every 1,000 planned home births, four babies die, versus two of every 1,000 born in a hospital. The data in the statement show "that potential for harm to mothers and babies exists in childbirth in all settings," said Dell Horey of La Trobe University in Victoria, Australia, who was not part of the ACOG statement.

"I think ACOG has been pretty consistent that we believe the safest place for child birth is in a hospital or accredited birthing center," Barth said. "At the same time, there is a growing body of evidence to help women make the decision that is right for them and their families."

A safe planned home birth requires the absence of any preexisting disease in the mother, the absence of any disease or complications arising during pregnancy, a singleton fetus, a head first presentation, gestational age of at least 36 and not more than 42 weeks, spontaneous labor, arrangements for emergency transport within an integrated healthcare system, and the availability of physician, a certified nurse midwife, certified midwife, or a midwife whose education and licensure meet International Confederation of Midwives' Global Standards for Midwifery Education, according to the statement.

Ole Olsen of the University of Copenhagen in Denmark, who was not part of the ACOG statement, told Reuters Health by email, "If things in the U.S. are as they are in Canada and Denmark (and probably everywhere else), doctors are generally reluctant to inform pregnant women about home birth as an option (which may only be relevant in parts of the U.S. as it has to be well organized to be relevant to bring up)."

"If home birth is well organized as it is in several countries and areas, home birth carries no additional risks; actually it decreases some risks for the mother," Olsen told Reuters Health by email.