Home Birth Linked to Increased Neonatal Mortality Rate

Sally - posted on 11/05/2010

For the 90% of women who are healthy and having a normal pregnancy, the hospital is a MUCH more dangerous place to give birth--both for mom and baby. It has been for as long as births have happened in hospitals. Until hospitals start caring more about normal childbirth than about ACOG having power, that isn't going to change.

Mary - posted on 10/24/2010

Karen - no, being trained to intubate, and being proficient at it are not one in the same. Where I work, all our house pediatricians are trained to intubate newborns...but very few of them do it often enough to be not just good, but quick about it. Honestly, it is our NICU CRNP's who are best at it; they do it on a fairly regular basis. My guess is, despite being trained, midwives who attend home births don't need to do this frequently enough to maintain both the skill, as well as a comfort level with doing so. I am happy to hear that there are 2 providers present for home births, though.

Johnny - posted on 10/23/2010

I was just going to say the same as Karen (I think we may live in the same province). Where I live, midwives are trained to intubate. It is part of their schooling. I still suspect that some of the differences are due to training and registering practices, and the medical community's view of home birth. I am not slagging nurses & OB's. My OB performs home births and supports them. Many of the midwives here were once L & D nurses, and my fantastic and wonderful L & D nurse was a midwifery student as well. My experience is not of some sort of separation of these 2 types of practice, but of them gradually coming to work well together. I just suspect that when the traditional medical community so resoundingly rejects a practice that functions well in many other places, and produces study after study of negative outcomes that are not reflected in studies from elsewhere, that those who choose to ignore this advice and proceed with homebirth, may be taking greater risks because they are ideologically more extreme and are not receiving support from the broader medical community. I am criticizing the AMA, not individual doctors and nurses. I think their politicized policy may be part of the problem rather than the solution.

April - posted on 10/23/2010

thank you Mary for some of the points you made. I have learned so much! i am now going to make a list of all the questions I want to ask my future midwife! (i.e. Are you trained to intubate?)

Karen - posted on 10/23/2010

My midwife was trained to intubate and carried oxygen as is regulated by the province. Also regulated is the requirement for 2 care providers to be present for the birth at a home birth. Mary, would these things affect your opinion at all?
(My good friend is also a L&D nurse - she planned a home birth and said she would never prefer to deliver in the hospital.)

Caitlin - posted on 10/22/2010

My OB was great, and I had him for my first delivery, and another OB I had for the second (he was awesome too). The onyl reason I was cranky about the pitocin is it's hospital policy because they can't have that many moms just waiting for the real contractions to take hold, and were going to send me home, but I had already called in favours to have my older daughter watched by family, so I wasn't going back home for 6 or 10 hours or so just to go back after.

Krista - posted on 10/22/2010

I don't view it as a blanket condemnation of home births, but rather identifying a problem, and suggesting that further investigation is needed on how to best deal with it.

Exactly. The study is not saying that home births are awful and should be abolished. It is simply saying that there is a need to establish a best practices model so that the risks inherent in home births are reduced as much as possible.

And I'm also not a fan of a lot of the doctor/hospital/nurse-bashing that I see on here. Yes, some people have had negative experiences. But to condemn the entire medical community as a whole, and to paint them as selfish assholes who are solely concerned with sticking to a schedule...well, it's a pretty huge insult to the scores of excellent doctors, nurses and support staff out there who genuinely care about their patients, who delight in every new baby born, who fight tooth and nail to save every baby who isn't doing well, and who have safely delivered millions of new human beings into the world. My Ob-Gyn was excellent. Most of my nurses were excellent, and even the ones who weren't excellent were at least competent. My mom is a nurse. My best friend is a nurse.

If you didn't like your own doctor or nurse, that's your prerogative, but I too, am getting damn tired of all of them being tarred with the same brush.

Kate CP - posted on 10/22/2010

I think I would be happier if more OBGYNs actually did home births to see what it was like for themselves. A lot of OBGYNs will just freak out at the thought of birthing outside of a hospital and I find that kind of sad. I have no problem giving birth in a hospital (I'm going to do it again in February with a *fabulous* OBGYN) but I think that a lot of people in the obstetrics field are too quick to condemn a home birth or birth center birth because they've never participated in one.

Isobel - posted on 10/22/2010

well Mary, it's clear that you got into the field for the millions ;P cha-ching

Mary - posted on 10/22/2010

Lisa, I want to add, I am not anti-home birth, and I am very pro-midwife. I would never, in a million years, consider a home birth, because I have seen all that can go wrong, and how quickly things can deteriorate, even with all of the necessary personnel and equipment immediately available. No matter how small the risks, it was not one I was willing to take with my child. I don't judge those who do, either, but I DO resent the hell out of people constantly bashing OB's, and acting as if their only goal is to malevolently "control" the childbirth process for their own selfish interests. It simply is not true.

Mary - posted on 10/22/2010

Lisa, there are so many variables...but actually, a few of these deliveries I am referring to had either abnormally short cords (not even long enough to get that baby up on mom), tight nuchal cords that either had to be reduced or cut, or true knots. I see what you are insinuating, but I work with a large midwifery practice that does not cut the cord in what you would consider a premature fashion. Some of these were precipitous deliveries due to a partial or full abruption, in which case the cord is no longer pulsating, since the placenta has already separated .

As for a midwife performing a full resusc on her own....first of of all, oxygen is not the only thing needed. Should an infant require more than 2 minutes of bag/mask ventilation, NRP guidlines do recommend intubation to maximize oxygenation. I don't know if you have ever tried to intubate an infant, but it is something that requires MUCH skill, practice and continued exposure. No, that is NOT something midwives are skilled in. Not to mention, a resusc of this level NEEDS two skilled caregivers. It all goes down so quickly, a few minutes at most, but as I said, those minutes are vital to long term outcomes.

Minnie - posted on 10/22/2010

Just wondering, Mary- were the umbilcal cords of those babies who required extensive resuscitation cut before they stopped pulsating? As long as it is pulsating, oxygen is still going to the baby.

Most midwives carry oxygen with them to home births. I'm curious as to how you are claiming that "most skilled midwife is NOT typically adept at more than the basics initial stimulation and preliminary resusc." What is your basis for this?

Mary - posted on 10/22/2010

The point that some of you seem to be missing is that this study is focusing on NEONATAL outcomes. It actually acknowledges some of the advantages of home births - "...lower rates of lacerations, hemmorhage, and infections..."

I guess because I am an L&D nurse, my interpretation of this study is a bit different (perhaps, in part, because I wasn't so quick to brush it off as propoganda by evil doctors). Wherever a woman gives birth, there is always a chance that, even in the absence of risk factors or even indications of either maternal or fetal distress, a baby can be born in need of resuscitative measures. Even the most skilled midwife is NOT typically adept at more than the basics initial stimulation and preliminary resusc, especially if she is on her own, and responsible for both mother and baby. Even if you live around the corner from the hospital, minutes are too long when there is a need to establish respirations...and those anoxic minutes equal brain injury, and sometimes death. This is why I find it comletely plausible that neonatal mortality IS higher with home births; I have seen numerous spontaneous vaginal births (without ANY risk factors or interventions) where a baby came out needing extensive resuscitation in those first critical minutes. Babies are pretty resilient, and barring any unforseen or underlying conditions (such as cardiomyopathy or other congential issues), they tend to repsond quickly, and be none the worse for it. However, had the appropriate resources and equipment not been IMMEDIATELY available, that same baby could vey well have sustained either long-term damage, or even died. In the case of unknown congential issue that is not diagnosed prenatally (and not everything can be diagnosed by those ultrasounds), that baby will most likely not survive the time required to call 911 and be transported to an appropriate facility. This can, and does occur, in low risk pregnancies.

What I take away from this study is that there is a need to look at what safety measures are in place for the BABY alone, and how to best prepare and care for an infant born compromised, particularly in the home birth setting. I don't view it as a blanket condemnation of home births, but rather identifying a problem, and suggesting that further investigation is needed on how to best deal with it.

Kelina - posted on 10/22/2010

No one in ten are not small numbers but how many of those are high risk pregnancies? And then how many of those are low risk pregnancies who are allowed to give birth at home? I agree someone living way out in the boonies who's high risk giving birth at home is not a good idea, nor do I think freebirth is the best option for the women although I can understand why someone with no access to a midwife would choose it, but for a lot of women giving birth at home is just as safe as giving birth in the hospital. And My issue with the study is their wording. then again maybe they cite actual numbers in their study, but i haven't been able to find it online. Their last line may say taht state for the benefit of all regardless of chosen location, but saying something like triple, rather than stating the actual numbers is a tactic i would use to manipulate someone into thinking my way, and a tactic i've seen used many times.

Isobel - posted on 10/22/2010

I'm willing to bet that that's the difference though Carol...not everybody is urban with good access to a hospital...for many women it can take hours to get to a hospital AFTER they know that there is a problem.

I do believe in home births, I would probably have one myself if I had another baby...but I would have a trained midwife, and a back up plan...and if I lived far away from a hospital...I would suck it up and have the baby there, because if there is a one in ten chance of my baby needing medical treatment...I'm gonna make sure that they can get it.

one in ten are not small numbers folks.

Johnny - posted on 10/22/2010

I must say I am rather surprised by this study. The government of our province opened up and began encouraging the accessibility of home births with registered midwives or obstetricians (yes, here a few do home births) about 15 years ago. The results have been subject to rigorous study and analysis. There has been no similar conclusions at all. In fact, for urban women with reasonable access to a hospital in an emergency, many service providers offer home birth as an equal option. Personally, I have to wonder if there is any effect on this study as a result of the ideological stance of the home-birther in many parts of the US. Where it is difficult to obtain and opposed by the medical establishment, people may become so focused on taking a stance that they are less willing to follow up on warning signs. Who knows? Just a thought.

Mary - posted on 10/22/2010

I see that most of you interpreted this incorrectly, and were erroneously quick to jump on the doctor-bashing bandwagon.

Perhaps you chose to ignore the last sentence of the study's conclusion:

"...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."

While I understand that many of you enjoy faulting and crticizing medical professions, you were a bit to caught up in your self-righteousness to actually see that this was NOT just a condemnation of home birth by greedy, power-hungry docs. It was a study that looked at neonatal outcomes, and suggested that further study is needed to IMPROVE these outcomes for the benefit of ALL, (and I'll restate) "...REGARDLESS OF CHOSEN BIRTH LOCATION".

Jennifer - posted on 10/21/2010

Well here in the UK a home birth is just as safe as a birth in a hospital. I plan that with my second I'll have a home birth as I wasn't allowed one with Logan due to complications at his 20 week scan. So to be quite honest bollocks to the study!

Kate CP - posted on 10/21/2010

Yea, I'm not buying it.

Minnie - posted on 10/21/2010

I read this quote the other day: "When pursuing truth, it is wise to be skeptical of research conducted by or for the very group that stands to gain the most from a particular outcome." - Jo Stepaniak



Let's take a wild guess as to whether research evaluating the safety of homebirth vs hospital birth carried out by the ACOG is objective or not.



This is like Nestle or Similac conducting research on breastfeeding and concluding that formula-feeding is safer because of the 'risk' of disease or environmental contaminants in breastmilk.

Laura - posted on 10/21/2010

First of all, I have a credibility issue with the study: The ACOG has never supported home births and they are the ones publishing tha article that gives support to that point-of-view. As a reader I automatically became suspicious of their motives and the article worded the outcome in such a way as to instill fear into expectant moms before citing the data. Turns out that there are some benefits to home birth as well as risk. By the end of the article it even admitted that the data used was scant and that further study was needed. yet it was apparently enough to make scary proclaimations about home birth mortality! The research might have had more impact if the study were done by a nuetral party and not a group that opposes home birth to bigin with. Ultimately it is the woman's choice where she delivers...

Mylene - posted on 10/21/2010

I think that home births are a great choice for low risk pregnancies if it is the mother's wishes. I agree with caitlin that a good midwife will refer you to an hospital is there is any doubt about the safety of the home birth. I think the statistics in the article are twisted to make home birth look like a HUGE risk when in fact it is barely more risky (for a normal pregnancy). We have to keep in mind that this article was written by a gynecologist who is most likely very biased against everything that is not done in a traditional medicine environment. home birth is not for me but I strongly believe women should have the right to choose where they want to give birth, providing that there are no health concerns for the child or mother. If complications are foreseen, then I don't think giving birth at home is a smart choice at all.

"Future research needs to be directed at identifying contributors to and reducing the apparently excessive neonatal mortality among planned home births,"

Excessive? It is sad that children die at birth and I know we all wish we could completely eradicate the problem but we also have to be realistic. Some children are, unfortunately, unable to live outside the womb and stopping women from giving birth at home isn't going to solve the issue.

Kelina - posted on 10/20/2010

So first off, what they don't have there is actually numbers. Triple sounds like a high number do you know what the actual number is? Neonatal mortality in hospitals is 1 in 1000. So triple that is only 3 in 1000. that's only 0.3%! Here's an article that came out in time this year http://www.time.com/time/magazine/articl...,9171,2011940-1,00.html And here's another article, I knew this sounded familiar for some reason, about the article in question. http://www.huffingtonpost.com/melissa-ch... I'm assuming she's actually read the article in question because I haven't. The link you posted simply takes you to a login page. i think doctors have been against homebirth since women began having babies in hospitals. Did you know that only(if memory serves) 10-15% of births need medical intervention? do you know what the national average is? I believe is between 32 and 35% in canada and the states, meaning 2-3 times whats needed! And that's only the average! I've read stories of some practices having an over 40% rate of c-section. For the most part, pregnancy and childbirth is a natural process, not the medical condition that many doctors seem to treat it as. And personally, I'm fine with that rate of 0.3%! My second baby is scheduled to be born at home in a couple of months.

Caitlin - posted on 10/20/2010

Well, I can see how there are fewer epidurals and such given for home births and all of that stuff, but the thing about that is, that a responsible midwife will not ALLOW you to deliver at home if they forsee those problems arising during the delivery of the baby. If you are not healthy enough, or the baby seems to big, you will be refered to the hospital for a birth there. I'm totally for the right of a mother to chose, but when there are so many things that can go wrong during childbirth, I am just not willing to accept that risk that they may happen to my child and I (or my baby) will receive delayed medical care because of it. With my first, I had bleeding issues afterwards, where I gushed for a while, and they were talking transfusion after I gave birth, but luckily I didn't need it, I was just severely anemic for a while, also the baby got stuck. They didn't forsee it, but my pelvis was pushing her back up the birth canal and she was in distress. That could have caused serious issues at a home birth, seeing as it all took 15 minutes from begining of first push (and a few subsequent pushes to determine the head was not passing) and the heart rate dropped. They had a team in my room, the forceps out and the baby on my chest perfectly fine (with a bruise and small scrape from the forceps - nothing permanent) in 2 minutes after the heart rate drop. That wouldn't have happened at a home birth.

I'm no professional, but from a mothers point a view, I would have prefered a more relaxed environment to give birth, the hospital put me on pitocin twice to speed it up (the second time they said it was pitocin or go home). It wasn't the greatest experience in the world (the childbirth part) but holding my baby for the very first time WAS the greatest thing in the world, and to me, it didn't matter where I was when that happened, as long as we were both safe.