Home Birth Linked to Increased Neonatal Mortality Rates

February 7, 2014

The risk of death in the first 28 days of life was roughly 4 times higher for babies delivered at home by midwives than babies delivered at a hospital by midwives, new research shows.

The rate of neonatal death was roughly 4 times higher for babies delivered at home by midwives than babies delivered in the hospital by midwives, according to a study presented today at the Society for Maternal-Fetal Medicine’s 34th annual meeting, The Pregnancy Meeting™, in New Orleans.

The researchers emphasized that 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 past decade. In the largest study of its kind, using CDC data on nearly 14 million linked infant birth and neonatal death data, term singleton US births, researchers at New York-Presbyterian/Weill Cornell Medical Center found the absolute risk of neonatal mortality was 3.2 per 10,000 births in midwife hospital births, and 12.6 per 10,000 births in midwife home births. For first-time mothers, the absolute risk of neonatal mortality further increased to 21.9 per 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 7-fold if this was the mother’s first pregnancy, and to about 10-fold in pregnancies beyond 41 weeks,” said Amos Grunebaum, MD, a main author of the study.

The excess total neonatal mortality for deliveries performed by home midwives was 9.3 per 10,000 births, or about 18 to 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 annual rate of 10%, then the excess total neonatal mortality of home births by midwives would nearly double, from about 16 to 17 in 2009 to about 32 in 2016.

Given the study’s findings, Dr Grunebaum and Frank Chervenak, MD, the second main author of the study, said that obstetric practitioners have an ethical obligation to disclose these 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.

These authors also said that hospitals should create a welcoming and comfortable birthing environment and, perhaps more importantly, address unnecessary obstetric interventions, naming both environment and unnecessary interventions as a primary motivation for couples to choose a planned homebirth.

Study co-authors include Laurence B. McCullough, PhD, at Baylor College of Medicine and Weill Cornell Medical College, Katherine J. Sapra, MPH, at Columbia University, Robert L. Brent, MD, PhD, at Thomas Jefferson University and Weill Cornell Medical College, Malcolm I. Levene, MD, FRCP, FRCPCH, at the University of Leeds, and Birgit Arabin, MD, at Philipps University and Clara Angela Foundation.