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Infants Born at Home Are Twice as Likely to Die as Those Born in Hospitals

In this retrospective study, home delivery was associated with increased risk to both mothers and infants.

Managing childbearing more naturally through delivery at home has met with opposition from those who question the safety of home deliveries. To determine neonatal and maternal outcomes for hospital and planned home deliveries, researchers reviewed Washington State birth certificates for uncomplicated singleton pregnancies of at least 34 gestational weeks from 1989 to 1996; 10,593 hospital deliveries were compared with 6133 planned home deliveries (279 were attempted home births that were transferred to hospitals). Infant death certificates were also examined.

Mothers who intended to deliver at home were more likely to be at least 20 years old, married, nonsmokers, and insured than were mothers who delivered in hospitals. Compared with neonates born in the hospital, those born at home were 1.99 times more likely to die (95% CI, 1.06-3.73) and 2.31 times more likely to have a 3-minute Apgar score lower than 3 (95% CI, 1.29-4.16). Nulliparous women who had planned home deliveries were 1.73 times more likely to have prolonged labor (95% CI, 1.28-2.34) and 2.76 times more likely to have postpartum bleeding (95% CI, 1.74-4.36) than were those with hospital deliveries.

Comment: In this retrospective study, women who delivered at home had fewer risk factors than those who delivered in hospitals. However, women who delivered at home put themselves and their infants at greater risk, even considering that birth certificates are notorious for misclassifying events (such as accidental home births). Women planning home deliveries should be counseled about this approach's higher risk for neonatal death.

— Sandra Ann Carson, MD

Published in Journal Watch Women's Health October 22, 2002

Citation(s):

Pang JWY et al. Outcomes of planned home births in Washington State: 1989-1996. Obstet Gynecol 2002 Aug; 100:253-9.

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