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Home Births Linked to More Infant Deaths

Excerpt By Julie Steenhuysen, Reuters Health

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 in Seattle.

"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," he said.

"Women should have a very informed conversation with their home-birth provider, asking about what safety measures should be in place," Benedetti advised.

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 of experience.

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 during delivery.

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.

Reference Source 89


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