The number of babies born at home has grown in the US during the past 10 years. But a new study shows that those babies are more likely to be stillborn and have a higher risk for seizures or neurological problems.
The study, published in the American Journal of Obstetrics and Gynecology, comes from researchers at New York-Presbyterian Hospital and Weill Cornell Medical Center, who analyzed data on more than 13 million US births.
It is the largest study of its kind, and the results were confirmed by examining birth files from the Centers for Disease Control and Prevention (CDC) from 2007 to 2010 to analyze deliveries by physicians and midwives, both in and out of the hospital.
The researchers looked at Apgar scores of 0, neonatal seizures and neurological dysfunctions. The Apgar test is a screening assessment that quickly studies the health of a baby 1 minute and 5 minutes after being born.
If a baby has a 5-minute Apgar score of 0, it is considered stillborn, but the researchers say that 10% of these babies survive.
Results of the study determined that home-born babies are 10 times more likely to be stillborn and almost four times more likely to have neonatal seizures or major neurologic dysfunction, compared with babies born in hospitals.
Dr. Amos Grunebaum, chief of labor and delivery at New York-Presbyterian/Weill Cornell Medical Center, says that "the magnitude of risk associated with home delivery is alarming."
"Parents-to-be need to know that if they deliver at home, their baby has a greater risk of dying or having a serious neurological problem."
The researchers note that the risk has to do with the location of the planned birth, not with the credentials of the person delivering the baby.
Dr. Frank Chervenak, a colleague of Dr. Grunebaum, notes that the "majority of pregnancies go smoothly. But in some instances, there can be unpredictable complications requiring immediate surgical intervention."
"If an emergency occurs at home that requires hospital transport," he says, "it's often difficult to beat the clock to prevent death or neurological issues."
The team also found that first-born babies who are born at home have the highest risk of stillbirth, at 14 times the risk compared with hospital births.
The clinical implications of the study's findings, according to the authors, are that home delivery is not "medically reasonable," due to the preventable adverse outcomes. They say that physicians should not encourage women to give birth outside the hospital.
However, they do note this stance should come with efforts to improve the "institutional setting of hospital delivery" in order to make it more homelike.
Dr. Chervenak adds:
"Childbirth is one of the most wonderful moments in humanity, and we recognize that parents may expect that giving birth at home will enhance the experience.
In the end, we need to be frank with parents about the risks. At the same time, physicians, midwives and other practitioners need to do everything we can to contribute to the compassionate care of mothers-to-be and their infants."