Births Linked to More Infant Deaths
LOS ANGELES (Reuters Health) - Twice as many infant deaths occurred
during home births than with hospital deliveries, according to
the results of a study in one US state.
Among births between 1989 and 1996 in the state of Washington, there
were 3.3 infant deaths per 1,000 home deliveries, compared with
1.7 per 1,000 hospital births, the investigators found. The study
excluded cases in which women had complications during their pregnancies.
"In these low-risk pregnancies, there's still an increased risk
of some adverse outcomes in home births," said study author Dr.
Jenny Pang, a pediatric fellow at the University of Washington
"It's still a small risk, but women should know there is an
added risk with home births," she told Reuters Health.
Infants born at home also were more than twice as likely after
delivery to have a very low Apgar score--a measure of newborn
health that takes into account heart rate, respiration and other
factors, Pang reported here Tuesday at the at the annual meeting
of the American College of Obstetricians and Gynecologists (ACOG).
She noted that respiratory distress was a factor that appeared
to result in more infant deaths with home births.
ACOG does not support home births. "Labor and delivery, while
a physiologic process, clearly presents potential hazards to both
mother and fetus before and after birth," states the group's policy
on home delivery. "These hazards require standards of safety which
are provided in the hospital setting and cannot be matched in
the home situation."
Study author Dr. Thomas Benedetti, an obstetrician/gynecologist
at the University of Washington, said he agrees with that policy.
"But we should continue to look at the data and make (home birthing)
as safe as possible for women who chose an alternative method,"
"Women should have a very informed conversation with their home-birth
provider, asking about what safety measures should be in place,"
Provisions should be made so that an ambulance is readily available
to take a woman or infant in distress to a nearby hospital, and
a doctor should be lined up in case of an emergency, he said.
He stressed that women should look for a home-birth provider,
often a midwife, with training--the more the better--and plenty
And women with medical conditions that might complicate a birth,
such as gestational diabetes or pregnancy-induced hypertension,
should never attempt a home delivery, he cautioned.
Deanne Williams, executive director of the American College
of Nurse-Midwives in Washington, DC, and a midwife herself, said
the study findings are "unusual."
"Most studies have found very similar outcomes" between home
and hospital births, she said. Williams said she would like to
see more detailed published information about the study before
drawing any conclusions about the validity of the findings.
About 1% of births attended by nurse-midwives occur in the home,
with the vast majority in hospitals, she noted.
In the new study, the researchers analyzed data from birth certificates
and infant death certificates for children born in Washington
from 1989 to 1996. They excluded cases in which the infant was
very premature (born at or before 34 weeks of gestation), the
woman was pregnant with twins or other higher-order multiples
or she had medical conditions that could have led to complications
After ruling out those cases, there were a total of 6,133 home
births, which were usually attended by a midwife but sometimes
by a doctor. That information was then compared to a random sample
of 10,593 hospital births involving healthy women.
Overall, about 2% to 3% of all births in Washington occur in
the home, compared with about 1% nationally, the researchers said.
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