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Home birth associated with higher death rate

1 July, 2010

Home birth associated with higher death rate

Home birth is associated with a tripling of the neonatal mortality rate, say US researchers, following their analysis of a number of planned home birth studies from around the world. Posted 1 July 2010, by Maura O'Malley

Home birth is associated with a tripling of the neonatal mortality rate, say US researchers, following their analysis of a number of planned home birth studies from around the world.

The overall neonatal death rate was almost twice as high in women who had a planned home delivery compared to a hospital delivery and the rate was almost tripled in nonanomalous offspring.

Investigators conducted a meta analysis of peer-reviewed literature and extracted morbidity and mortality data for 342,056 planned home and 207,551 planned hospital deliveries.

However, mothers in planned home births experienced significantly fewer medical interventions including epidural analgesia, electronic fetal heart rate monitoring, episiotomy, and operative vaginal and caesarean section deliveries.

Furthermore, women who had home birth deliveries had fewer infections, perineal and vaginal lacerations, haemorrhages and retained placentas. Data also showed that planned home birth were characterised by less frequent premature and low.

Investigators observed that perinatal mortality rates for planned home and hospital births were similar overall.

The authors say that the results are ‘striking’ as women planning home births were of similar and often lower obstetric risk than those planning hospital births.

The lead investigator Maine Medical Center’s Dr Joseph R Wax said: ‘Women choosing home birth, particularly low-risk individuals who had given birth previously, are in large part successful in achieving their goal of delivering with less morbidity and medical intervention than experienced during hospital-based childbirth. Of significant concern, these apparent benefits are associated with a doubling of the neonatal mortality rate overall and a near tripling among infants born without congenital defects.’

The RCM’s practice and standards development advisor Mervi Jokinen said: ‘While it is interesting, I do question the validity of its findings for the UK. Comparison of the results is difficult because the study’s authors are working with data collected differently in many countries.


‘Here we have services delivered by midwives who are skilled and experienced at home births and resuscitating newborns. This is perhaps in contrast to many of the other countries this research covers.  It is not clear who or how these services are delivered in other countries and whether they are comparable to the UK, so comparing outcomes is not straightforward. The authors of the study refer to lack of appropriate training or equipment perhaps being associated with increased neonatal deaths.

‘Other studies of midwifery-led care and homebirth in other countries have so far indicated improved outcomes for mothers, and no increase in risk for the baby as long as the appropriate selection of women takes place. Also the numbers of homebirths are still very low, even in the UK, making meaningful and concrete conclusions about the results difficult. We are waiting for the results of a UK study on place of birth which should give us statistically valid results.’

Wax JR, Lucas LF, Lamont M, Pinette MG, Cartin A, Blackstone J. (2010) Maternal and newborn outcomes in planned home birth vs planned hospital births: a metaanalysis. Journal of Obstetrics & Gynecology 203(3): doi 10.1016/j.ajog.2010.05.028

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