Planned home births riskier than hospital births, ACOG says

Although the absolute risk of planned home births is low, published data show that they carry a 2- to 3-fold greater risk of newborn death than planned hospital births, according to a recently released opinion from the American College of Obstetricians and Gynecologists (ACOG) Committee on Obstetric Practice.

The Committee Opinion, published in the February issue of Obstetrics & Gynecology (2011;117[2 pt 1]:425-428), states that, based on available information, “hospitals and birthing centers are the safest setting for birth” while affirming “the right of a woman to make a medically informed decision about delivery.”

“As physicians, we have an obligation to provide families with information about the risks, benefits, limitations, and advantages concerning the different maternity care providers and birth settings,” says Richard N. Waldman, MD, president of ACOG. “It’s important to remember that home births don’t always go well, and the risk is higher if they are attended by inadequately trained attendants or in poorly selected patients with serious high-risk medical conditions such as hypertension, breech presentation, or prior cesarean deliveries.”

ACOG recommends offering women who decide to deliver at home standard prenatal care, including screening for and treatment of group B streptococcus, genetic screening, and screening for human immunodeficiency virus. It also urges that women contemplating home birth consider whether they are healthy and at low risk of complications; work with a certified nurse midwife, certified midwife, or physician who practices “within an integrated and regulated health system”; and have ready access to consultation and a plan for safe and quick transfer to a nearby hospital in case of emergency.

Previous cesarean delivery is an absolute contraindication to home birth, the Committee Opinion states, because of the risk of uterine rupture or other complications. The committee also advises against home birth for women at more than 42 weeks’ gestation, those who are carrying twins, and those who have a breech presentation, all of which increase the risk of perinatal death.