A five-year study of home births in Oregon
found an elevated rate of deaths among babies that had to be transferred to the
hospital because something went wrong during the delivery.
However,
experts said this doesn't necessarily mean that home births are dangerous. Many
of the babies and mothers had conditions that put them at higher risk of
complications, such as preeclampsia (high blood pressureduring
birth) or breech position (when the baby is feet first instead of head first).
The
researchers looked at medical records on
223 home births in Oregon from 2004 to 2008, in which the babies were
transferred to a hospital because of problems during or right after delivery.
Eight babies died, according to the study to be presented Tuesday at the
American College of Obstetricians and Gynecologists (ACOG) annual meeting in
San Diego.
Three
of the babies were in the breech position; four of the mothers had
preeclampsia; and two mothers delivered postdate, usually defined as a
pregnancy of 42 weeks or longer (40 weeks is generally considered full-term).
Of the
eight deaths, one infant had congenital defects "not
compatible with life," Dr. Stella Dantas, of the department of obstetrics and
gynecology at Northwest Permanente, P.C. Physicians and Surgeons in
Beaverton, Ore., and colleagues noted in an ACOG news release. All of the women
except one were assisted by a licensed midwife.
"Our
study showed that each of the neonatal deaths had
higher . . . risk conditions associated, such as breech, hypertensive
disorders, meconium [first intestinal discharge of newborns], postdates and/or
anomaly. More data is needed to examine how pregnant women with these
conditions are managed out of hospital, if there is evidence to support women
with these conditions having out of hospital births, and
what the barriers are for hospital transport," Dantas said.
Nearly
30,000 women gave birth at home in the United States in
2009, according to the U.S. Centers for Disease Control and Prevention's
National Center for Health Statistics.
Though
still accounting for less than 1 percent of all births, home births in the
United States increased by 29 percent between 2004 and 2009.
Home
births in the United States tend to be more common among white women -- one in
90 births was a home birth -- but less likely among other racial and ethnic
groups, CDC statistics show.
In
addition, the popularity of home births varies among the states. Montana has
the highest percentage of home births, at nearly
2.6 percent, followed by Oregon and Vermont, with nearly 2 percent each.
Women
who opt to give birth at
home often object to turning a natural process into a medical problem in need
of doctors and hospitals, said Dr. Mary Norton, director of perinatal research
at Stanford University Medical Center.
Some
women want to give birth without painkillers such as epidurals, Norton said.
They may want to have "more control" over the birth experience; may
feel more comfortable in their own surroundings; or may want to have multiple
people in the room when they deliver, something many hospitals limit, Norton
added.
"There
is a small percentage of women who feel very strongly they don't want all the
accoutrements of delivering in the hospital, and they have enough distrust of
the medical system that their best option is to deliver at home," Norton
said.
While
many women can give birth at home safely, women choosing home birth should
recognize there are risks, Norton said.
"For
most healthy women, childbirth is a safe, low-risk procedure and for many
women, it can safely happen at home," Norton said. "But there are
times when things go wrong, and they can be hard to anticipate, and they are
much more common when there is a high-risk situation, such as high blood
pressure, preeclampsia, breech and being postdate."
Whereas
birthing centers often have systems in place to transfer a woman to a hospital
in case of emergency, women at home may have to wait longer for an ambulance,
or it may be difficult to move a woman who is in labor onto a gurney and
transport her to a hospital.
In the
Oregon deaths, it's unknown if the women knew about the conditions prior to
deciding to give birth at home, or if the problems arose during labor. Either
way, these women should
have been in a hospital, Norton said.
"They
were all very high-risk conditions and not patients that should have been
delivering at home," Norton said.
Because
this study was presented at a medical meeting, the data and conclusions should
be viewed as preliminary until published in a peer-reviewed journal.
More
information: The American Pregnancy Association has
more on home births.
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