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 Hospitals and accredited birth centers are still the safest place
for a woman to give birth, according to the American College of
Obstetricians and Gynecologists (ACOG).
In a newly published Committee Opinion, the College describes times
when home birth should not be considered, such as when the fetus is
in a breech or transverse position rather than head-down, when the
mother is pregnant with multiples or when she’s had a Cesarean
section in the past.
The last ACOG Opinion on this topic was published in 2011. Since
then, a number of studies have cleared up some uncertainties about
birth outcomes, particularly as home birth is practiced in the U.S.,
said primary author Dr. William H. Barth Jr., chief of the Division
of Maternal-Fetal Medicine at Massachusetts General Hospital.
“For example,” he told Reuters Health by email, “a large study of
planned home birth versus planned hospital birth in Oregon, a state
that probably leads others in the organization and reporting of
planned home birth, has shown that planned home birth is associated
with fewer labor inductions, fewer labor augmentations, fewer
operative vaginal deliveries and importantly, significantly fewer
cesarean deliveries.”
“However, this and other more recent studies conducted in the U.S.
confirm that planned home birth is also associated with higher rates
of low Apgar scores, neonatal seizures or serious neurologic
disorders and neonatal death,” he said. “The absolute rates of these
are low, but they are consistently higher with planned home birth.”
Planned hospital births more often involve labor induction, Cesarean
section, severe perineal lacerations and other complications
compared to planned home birth. But babies born by planned home
birth are twice as likely to die in the process and three times as
likely to experience a seizure as those born in a hospital,
according to the statement.
For every 1,000 planned home births, four babies die, versus two of
every 1,000 born in a hospital.
The data in the statement show “that potential for harm to mothers
and babies exists in childbirth in all settings,” said Dell Horey of
La Trobe University in Victoria, Australia, who was not part of the
ACOG statement.
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“I think ACOG has been pretty consistent that we believe the safest
place for child birth is in a hospital or accredited birthing
center,” Barth said. “At the same time, there is a growing body of
evidence to help women make the decision that is right for them and
their families.”
A safe planned home birth requires the absence of any preexisting
disease in the mother, the absence of any disease or complications
arising during pregnancy, a singleton fetus, a head first
presentation, gestational age of at least 36 and not more than 42
weeks, spontaneous labor, arrangements for emergency transport
within an integrated healthcare system, and the availability of
physician, a certified nurse midwife, certified midwife, or a
midwife whose education and licensure meet International
Confederation of Midwives’ Global Standards for Midwifery Education,
according to the statement.
Ole Olsen of the University of Copenhagen in Denmark, who was not
part of the ACOG statement, told Reuters Health by email, "If things
in the U.S. are as they are in Canada and Denmark (and probably
everywhere else), doctors are generally reluctant to inform pregnant
women about home birth as an option (which may only be relevant in
parts of the U.S. as it has to be well organized to be relevant to
bring up)."
"If home birth is well organized as it is in several countries and
areas, home birth carries no additional risks; actually it decreases
some risks for the mother," Olsen told Reuters Health by email.
SOURCE: http://bit.ly/2aEpfDI American College of Obstetricians and
Gynecologists, August 2016.
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