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Home births “don’t always go well,” observes ACOG

A new Committee Opinion weighs in on the safety of home birth versus hospital management—and finds it lacking.

February 2011 · Vol. 23, No. 2

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Erin E. Tracy, MD, MPH (August 2009)

Although the absolute risk of neonatal death after planned home birth is low, published medical evidence demonstrates that it is two or three times as high as the rate for planned hospital birth. So says a new Committee Opinion from ACOG.1 A review of data by the Committee on Obstetric Practice also found that planned home birth among low-risk women is associated with fewer medical interventions than planned hospital birth is.

“As physicians, we have an obligation to provide families with information about the risks, benefits, limitations and advantages concerning the different maternity care providers and birth settings,” said Richard N. Waldman, MD, president of ACOG. “It’s important to remember that home births don’t always go well, and the risk is higher if they are attended by inadequately trained attendants or in poorly selected patients with serious high-risk medical conditions such as hypertension, breech presentation, or prior cesarean deliveries.” Based on the available data, ACOG believes that hospitals and birthing centers are the safest place for labor and delivery.

Women planning a home birth should get comprehensive prenatal care

Although ACOG does not support the practice of planned home birth, it does emphasize that women who decide to deliver at home should be offered standard components of prenatal care, including Group B strep screening and treatment, genetic screening, and HIV screening. It also is important for women thinking about a planned home birth to consider whether they are healthy and to ascertain what their level of risk may be, ACOG says. Working with a certified nurse midwife, certified midwife, or physician who practices in an integrated and regulated health system also is advisable. In addition, women should have ready access to consultation and have a plan for safe and quick transportation to a nearby hospital in the event of an emergency.

A previous cesarean delivery is an absolute contraindication to a planned home birth because of the risks involved, which include uterine rupture, according to the Committee Opinion. Women who want to try for a vaginal birth after cesarean are advised to do so only in a hospital where emergency care is immediately available.

Because of a greater risk of perinatal death in certain settings, a home birth is not advised for women who:

  • are postterm (more than 42 weeks’ gestation)
  • carrying twins
  • have a breech presentation.

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Reference

1. Planned home birth. ACOG Committee Opinion#476. Obstet Gynecol. 2011;117(2 part 1):425-428.

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