Home births: What are the maternal benefits? Fetal risks?

Study reveals lower risk of cesarean delivery but increased risk of Apgar <7 and neonatal seizures

For women who have or intend to have births outside of a hospital, the risk of cesarean delivery is significantly lower, but there is an increased risk of lower five-minute Apgar score and neonatal seizures compared with hospital births, according to a study presented at the annual meeting of the Society for Maternal-Fetal Medicine, held in February, in Dallas.

Yvonne W. Cheng, MD, PhD, from the University of California in San Francisco, and colleagues investigated whether neonatal outcomes differ for intended home births and births that occur at birthing centers versus hospitals. Neonatal outcomes were compared for 2,296,953 singleton, live, term births, according to location of delivery.

The researchers found that 0.47% of births occurred at birthing centers, while 0.54% of women had intended home births. The risk of cesarean section was significantly lower for women who intended to, or delivered, outside of a hospital (0.02 to 4% versus 24%; P < 0.001). However, for intended home births, there was a significantly increased risk of five-minute Apgar score lower than 7 (adjusted odds ratio [aOR], 2.08; 95% confidence interval [CI], 1.68 to 2.34), and neonatal seizures (aOR, 2.83; 95% CI, 1.40 to 5.71) compared with births in the hospital.

“This trade-off between maternal benefit and neonatal risk of deliveries outside of hospital should be weighed in the decision regarding birthing facility preferences,” the authors write.

The abstract is available at http://www.smfmnewsroom.org/annual-meeting/2011-meeting-abstracts/.

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