Researchers’ Corner: Giving Birth at Home Unbelievably Seems To Be On The Increase In U.S!

‘Perinatal mortality was higher with planned out-of-hospital birth than with planned in-hospital birth, but the absolute risk of death was low in both settings.’

The opinion here is strictly that of the researchers and not emobileclinic.

This happens a lot in Nigeria and unbelievably the frequency of planned out-of-hospital birth in the United States is said to have increased in recent years in a study published yesterday. This study assesses the perinatal risks of planned out-of-hospital birth versus hospital birth which however has been limited by cases of urgent transfer to the hospital; making a birth that was initially planned as an out-of-hospital birth to be misclassified as a hospital birth.

According to the researchers, in recent years, U.S. rates of planned out-of-hospital birth (i.e. births intended to occur at home or at a freestanding birth center) have increased. The rate of birth at home increased by 20% (from 0.56% to 0.67%) between 2004 and 2008 and by approximately 60% between 2008 and 2012, reaching 0.89% of all births. There has been a parallel trend in the use of birth centers, from 0.23% in 2004 to 0.39% in 2012.According to recent U.S. studies of out-of-hospital birth, women planning to deliver at home had lower rates of obstetrical intervention, and their infants had higher rates of complications and death. Potential explanations for these findings as they relate to obstetrical interventions include differences in models for obstetrical care (i.e. care provided by an obstetrician, by a certified nurse-midwife, or by certified professional midwife), in the practices of the birth attendant, in provider and maternal preference for (and the availability of) medical technology, and in maternal characteristics.

Few studies have compared outcomes at birth centers with those at other birth settings. A key shortcoming of prior studies of planned home birth is the classification of births by the eventual rather than the intended place of birth (i.e., intrapartum home-to-hospital transfers were counted as hospital births).

In 2012, the home birth rate in Oregon was 2.4%, which was the highest rate of any state; another 1.6% of women in Oregon delivered at birth centers. Before licensure became mandatory in 2015, Oregon was one of two states in which licensure was not required for the practice of midwifery in out-of-hospital settings. Although the 2003 revision of the U.S. Standard Certificate of Live Birth distinguishes planned home births from unplanned home births, at the national level there is still no way to disaggregate hospital births that were intended to occur at a hospital and those that had not been intended to occur at a hospital. On January 1, 2012, Oregon introduced new questions on the birth certificate to document the planned place of delivery at the time a woman began labor.

The researchers used birth-certificate data to assess maternal outcomes and fetal and neonatal outcomes according to plan delivery .They performed a population-based, retrospective cohort study of all births that occurred in Oregon during 2012 and 2013 using data from newly revised Oregon birth certificates that allowed for the disaggregation of hospital births into the categories of planned in-hospital births and planned out-of-hospital births that took place in the hospital after a woman’s intrapartum transfer to the hospital. ‘We assessed perinatal morbidity and mortality, maternal morbidity, and obstetrical procedures according to the planned birth setting (out of hospital vs. hospital)’ they said.

RESULTS

Planned out-of-hospital birth was associated with a higher rate of perinatal death than was planned in-hospital birth .The odds for neonatal seizure were higher and the odds for admission to a neonatal intensive care unit lower with planned out-of-hospital births than with planned in-hospital birth. Planned out-of-hospital birth was also strongly associated with unassisted vaginal delivery (93.8%, vs. 71.9% with planned in-hospital births; P<0.001) and with decreased odds for obstetrical procedures.

CONCLUSIONS

Perinatal mortality was higher with planned out-of-hospital birth than with planned in-hospital birth, but the absolute risk of death was low in both settings. (Funded by the Eunice Kennedy Shriver National Institute of Child Health and Human Development.)

More Information

The New England Journal of Medicine

‘Planned Out-of-Hospital Birth and Birth Outcomes’

A work of Jonathan M. Snowden, Ph.D. Etal