A study slated to be published in the September issue of the American Journal of Obstetrics and Gynecology is questioning safety of homebirth. The study was a metaanalysis which included 12 studies which met inclusion criteria. The researchers selected studies which were performed in developed Western countries, published in English-language peer-reviewed journals, and evaluated planned home vs. planned hospital birth outcomes. I will be spending the next couple of blog posts discussing this study.
First, let’s review the major findings. The researchers found that women who had planned home births experienced significantly fewer medical interventions, such as epidural anesthesia, continual electronic fetal monitoring, episiotomies, c-sections, and assisted vaginal deliveries (forceps/vacuum). They also had fewer infections, third and fourth degree lacerations (those that extend into the anal sphincter or through the rectum), hemorrhages, and retained placentas. Their babies were less likely to be born prematurely or be low birthweight. Sounds pretty good so far, doesn’t it?
But wait. . .the authors go on to deliver the news that the neonatal death rate (the death of an infant from the time of birth to 28 days of age) was almost three times as high in planned home births than planned hospital births! The researchers state that the most common cause of perinatal death in developed countries, after congenital anomalies, is anoxia (lack of oxygen) during labor/birth. They state that evidence suggests a significant decrease in deaths related to anoxia over the past two decades, speculating that the reason for the decrease in deaths is an increase in ultrasound, electronic fetal heart rate monitoring, labor induction, and c-section.
They do mention, however, that planned home births with a certified nurse-midwife or certified midwife (not a nurse) did not have any higher rate of neonatal deaths than the planned hospital group.
Ignoring the fact that planned home birth with a certified attendant had equivalent neonatal death rates as planned hospital birth, the researchers draw the conclusion of their study: the increased neonatal mortality rates at home are associated with less medical intervention during planned home birth.
In my next post, we will further dissect this metaanalysis and the 12 studies it reviewed.