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Neonatal mortality rates an increasing trend in home birth

In a study to be presented on Feb. 7 at 2:15 p.m. CST, at the Society for Maternal-Fetal Medicine’s annual meeting, The Pregnancy Meeting ™, in New Orleans, researchers will report that patients delivered at home by midwives had a roughly four times higher risk of neonatal deaths than babies delivered in the hospital by midwives. The increased neonatal mortality risk is associated with the location of a planned birth, rather than the credentials of the person delivering the baby.

The number of homebirths in the United States has grown over the last decade. In the largest study of its kind, using Centers for Disease Control data on nearly 14 million linked infant birth and neonatal death data, term singleton U.S. births, researchers at New York-Presbyterian/Weill Cornell Medical Center found the absolute risk of neonatal mortality was 3.2/10,000 births in midwife hospital births, and 12.6/10,000 births in midwife home births, and it further increased in first-time mothers to 21.9/10,000 births in midwife home deliveries. Neonatal mortality was defined as neonatal deaths up to 28 days after delivery.

“This risk further increased to about seven-fold if this was the mother’s first pregnancy, and to about ten-fold in pregnancies beyond 41 weeks,” said Amos Grunebaum, M.D.

The excess total neonatal mortality for deliveries performed by home midwives was 9.3/10,000 births or about 18-19 excess neonatal deaths a year from midwife homebirths. Based on the most recent 2012 births data, the authors concluded that if home births by midwives continue to grow at the present 10 percent yearly rate, then the excess total neonatal mortality of home births by midwives would nearly double from about 16-17 in 2009 to about 32 in 2016.

Given the study’s findings, Amos Grunebaum, M.D. and Frank Chervenak, M.D., the main authors of the study, said that obstetric practitioners have an ethical obligation to disclose the increased absolute and relative risks associated with planned home birth to expectant parents who express an interest in this delivery setting, and to recommend strongly against it.

The authors also continued to say that hospitals should create a welcoming and comfortable birthing environment, as well as address unnecessary obstetric interventions, both of which are often a primary motivation for planned homebirth.

Source

Abstract 57: Term neonatal deaths resulting from home births: An increasing trend

Authors: Amos Grunebaum1, Kate Sapra2, Frank Chervenak1

1New York Weill Cornell Medical College, New York, NY, 2Columbia University, New York, NY

Objective: Home births have increased over the last years. The objective of our study was to examine excess term neonatal mortality rates by birth location (hospital, birthing centers, and home births) and by providers (midwives, doctors, and “others” for home births) and to document the number of excess neonatal deaths resulting from the increase in home births.

Study Design: A retrospective cohort study using the CDC linked birth/infant death data set for term (>=37 weeks), >=2500 grams, singleton live births, excluding congenital anomalies from 2007 to 2009. Deliveries were categorized by setting: hospitals, birthing centers, and home as well as providers (midwives, doctors, and “others” for home births). Neonatal mortality (NNM) was defined as neonatal deaths up to 28 days after delivery. Hospital midwives served as reference.

Results: There were a total of 10,453,778 term deliveries between 2007 and 2009 which met study criteria: 9,526,450 (91.13%) were by hospital physicians, 826,543 (7.91%) by hospital midwives, 30,415 (0.29%) by midwives in freestanding birthing centers, 48,202 (0.46%) by midwives at home, and 22,168 (0.21%) by others at home. NNM for those delivered at home by others and by midwives, and those delivered in a freestanding birthing center was significantly higher than those delivered by midwives in the hospital: hospital midwives: 3.1/10,000 (RR:1); home others: 18.2/10,000 (RR: 5.87; 95%CI: 4.21-8.19), home midwives: 13.2/10,000; (RR: 4.32 95%CI: 3.29-5.68), freestanding birthing center: 6.3/10,000;(RR: 2.03; 95%CI: 1.28-3.24). The excess NNM for home births by midwives was 10.2/10,000 births (95% CI 6.9-13.2), and 15.0/10,000 births (95% CI 9.4-20.6) for home births by “others”.

Conclusion: Our study documents the number of excess term neonatal deaths resulting from home births. If home births continue to grow at a 6% per year rate, then excess yearly neonatal deaths from home births will increase by about 1/3 from about 31 in 2010 to about 42 in 2015.

Society for Maternal-

Fetal Medicine