Via British Medical Journal &The Guardian UK http://www.guardian.co.uk/lifeandstyle/besttreatments/2010/jul/02/home-birth-triples-risk-of-infant-death/print
HOME BIRTHS - BENEFITS & RISKS - REVIEW OF RESEARCH - MORE NEEDED
2 July 2010
Babies are three times more likely to die after planned home births than after hospital deliveries, a new review of the research says. Many of the deaths are probably related to breathing difficulties and failed attempts at resuscitation, say researchers. However, the overall risk of death is still very low.
Home births have become increasingly popular in the UK, as many expectant parents have sought a more natural setting for their baby's delivery, with fewer medical interventions. However, some doctors have expressed concern about the safety of home deliveries. Although women choosing home births are usually at low risk of labour-related complications, births don't always go as planned, and problems can arise for both mother and baby that require prompt medical attention.
Studies haven't yet given us a clear picture of how safe home births are compared with hospital births. This is partly because good-quality research has been lacking. Also, many studies have compared actual home births with actual hospital deliveries. This isn't an ideal comparison, as planned home births often become hospital deliveries if problems arise. This can mean studies underestimate the risks of home births.
To get around this problem, some studies have categorised births according to whether they were intended to be home based or hospital based, regardless of where they ended up. Researchers have now done a review of the best of these studies to see what conclusions they can draw. In total, they looked at 12 studies with 342,056 planned home births and 207,551 planned hospital deliveries.
Women having planned home births fared better in some respects than women having planned hospital deliveries. For example, they were less likely to develop an infection, have heavy bleeding, or have severe tears or cuts in and around their vagina.
However, their newborns had a higher risk of dying. Overall, babies without congenital birth defects were three times more likely to die after a planned home birth than after a planned hospital delivery. These findings are particularly striking given that women choosing home births are often at lower risk of labour-related difficulties than women delivering in hospital.
However, it's important to note that the chance of death was still very low. Only 15 in 10,000 babies died after having a planned home birth (0.15 percent), compared with 4 in 10,000 after a planned hospital delivery (0.04 percent).
The researchers can't be certain why newborn deaths were more likely with planned home births. However, they did find that a high proportion of home-birth deaths were related to breathing problems. In hospital, these deaths are often prevented with the help of specialised equipment and trained medical staff.
These finding should be fairly reliable. The review of studies was large and was carefully done. Also, the review's overall results were similar to what each study found individually. This strengthens the findings.
The countries examined by the study include the UK, the US, Australia, Switzerland, Sweden, and Canada. All these countries have modern healthcare systems, so the results should be reasonably applicable to the UK.
Some of the individual studies in the review were published in the 1980s, but most are fairly recent, with the largest trial looking at women who gave birth between 2000 and 2006.
We need more research to know exactly why babies are more likely to die after planned home births, and what steps might be taken to reduce this risk.
The review was done by US researchers with the Maine Medical Center in Portland, Maine. It appeared in the American Journal of Obstetrics & Gynecology, which is published by a company called Elsevier.
This study helps clarify the risks and benefits of home births, which you may find helpful if you're contemplating a home delivery.
However, there are many other things to consider, including how likely you are to have a difficult labour or complications requiring hospital care. Factors that can increase your risk include being very overweight, and having previously had a caesarean section or difficult birth.
Your midwife or doctor can help you weigh up these risks and decide whether a home birth is the right choice for you and your baby.
Wax JR, Lucas FL, Lamont M, et al. Maternal and newborn outcomes in planned home birth vs planned hospital births: a meta-analysis. American Journal of Obstetrics & Gynecology. 2010;203:1.e1–1.e8.
© BMJ Publishing Group Limited ("BMJ Group") 2010
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