Home Birth Poses Danger for Higher-Risk Pregnancies: Study

TUESDAY, May 8 (HealthDay News) — A five-year study of home
births in Oregon found an elevated rate of deaths among babies that had to
be transferred to the hospital because something went wrong during the
delivery.

However, experts said this doesn’t necessarily mean that home births
are dangerous. Many of the babies and mothers had conditions that put them
at higher risk of complications, such as preeclampsia (high blood pressure
during birth) or breech position (when the baby is feet first instead of
head first).

The researchers looked at medical records on 223 home births in Oregon
from 2004 to 2008, in which the babies were transferred to a hospital
because of problems during or right after delivery. Eight babies died,
according to the study to be presented Tuesday at the American College of
Obstetricians and Gynecologists (ACOG) annual meeting in San Diego.

Three of the babies were in the breech position; four of the mothers
had preeclampsia; and two mothers delivered postdate, usually defined as a
pregnancy of 42 weeks or longer (40 weeks is generally considered
full-term).

Of the eight deaths, one infant had congenital defects “not compatible
with life,” Dr. Stella Dantas, of the department of obstetrics and
gynecology at Northwest Permanente, P.C. Physicians and Surgeons in
Beaverton, Ore., and colleagues noted in an ACOG news release. All of the
women except one were assisted by a licensed midwife.

“Our study showed that each of the neonatal deaths had higher . . .
risk conditions associated, such as breech, hypertensive disorders,
meconium [first intestinal discharge of newborns], postdates and/or
anomaly. More data is needed to examine how pregnant women with these
conditions are managed out of hospital, if there is evidence to support
women with these conditions having out of hospital births, and what the
barriers are for hospital transport,” Dantas said.

Nearly 30,000 women gave birth at home in the United States in 2009,
according to the U.S. Centers for Disease Control and Prevention’s
National Center for Health Statistics.

Though still accounting for less than 1 percent of all births, home
births in the United States increased by 29 percent between 2004 and
2009.

Home births in the United States tend to be more common among white
women — one in 90 births was a home birth — but less likely among other
racial and ethnic groups, CDC statistics show.

In addition, the popularity of home births varies among the states.
Montana has the highest percentage of home births, at nearly 2.6 percent,
followed by Oregon and Vermont, with nearly 2 percent each.

Women who opt to give birth at home often object to turning a natural
process into a medical problem in need of doctors and hospitals, said Dr.
Mary Norton, director of perinatal research at Stanford University Medical
Center.

Some women want to give birth without painkillers such as epidurals,
Norton said. They may want to have “more control” over the birth
experience; may feel more comfortable in their own surroundings; or may
want to have multiple people in the room when they deliver, something many
hospitals limit, Norton added.

“There is a small percentage of women who feel very strongly they don’t
want all the accoutrements of delivering in the hospital, and they have
enough distrust of the medical system that their best option is to deliver
at home,” Norton said.

While many women can give birth at home safely, women choosing home
birth should recognize there are risks, Norton said.

“For most healthy women, childbirth is a safe, low-risk procedure and
for many women, it can safely happen at home,” Norton said. “But there are
times when things go wrong, and they can be hard to anticipate, and they
are much more common when there is a high-risk situation, such as high
blood pressure, preeclampsia, breech and being postdate.”

Whereas birthing centers often have systems in place to transfer a
woman to a hospital in case of emergency, women at home may have to wait
longer for an ambulance, or it may be difficult to move a woman who is in
labor onto a gurney and transport her to a hospital.

In the Oregon deaths, it’s unknown if the women knew about the
conditions prior to deciding to give birth at home, or if the problems
arose during labor. Either way, these women should have been in a
hospital, Norton said.

“They were all very high-risk conditions and not patients that should
have been delivering at home,” Norton said.

Because this study was presented at a medical meeting, the data and
conclusions should be viewed as preliminary until published in a
peer-reviewed journal.

More information

The American Pregnancy Association has more on home
births.

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