Perinatal Death Increased in Home Compared With Hospital Births

Babies born outside of hospital were around three times more likely to die than those born in hospital; according to new research from Israel. “This study matches the findings of larger studies conducted; in the United States and confirmed our hypothesis that childbirth in non-hospital settings; is far more dangerous than in hospitals,” said coauthor Eyal Sheiner, MD, PhD, chair of the Obstetrics and Gynecology Department, Soroka University Medical Center, Be’er-Sheva, Israel.

“There is no question that a hospital provides the most secure environment to give birth; both for mothers and their babies,” said Sheiner. “Even with the advances in modern medicine, childbirth is still traumatic for both the mother and child and it is critical to be prepare for any scenario,” he said.

Risk of Perinatal Mortality

For the study, lead author Gil Gutvirtz, MD, also of Soroka University Medical Center; and colleagues identified 243,682 singleton deliveries that occurred between 1991 and 2014; 3580 of them (1.5%) occurred outside of hospital. The nature of the database prevented the researchers from distinguishing between out-of-hospital births that were plan or unplan.

Women who gave birth outside of hospital were more likely to have had previous pregnancies (95.9% vs 76.1%; < 0.001); and inadequate prenatal care (26.2% vs 8.7%; P < .001) compare with those who had their babies in hospital.The rate of perinatal mortality that occurred in-hospital was 5 deaths per 1000 births, compare with 15 deaths per 1000 births outside hospital (P < .001).

After adjusting for factors including; gestational age, diabetes, hypertensive disorders, smoking, and ethnicity; the risk of perinatal mortality was still significantly higher among births occurring outside of hospital (adjusted odds ratio [OR], 2.6; < .001). Other notable differences between the groups include the fact that preterm births; were also more likely to occur in out-of-hospital deliveries (9.1% vs 6.8%; P < 0.001), as was the likelihood of low birth weight (weight < 2500 g; 11.6% vs 6.7%; P < .001).

Diabetes, Hypertension Lower in Out-of-Hospital Group

However, women who delivered out of hospital had a significantly lower likelihood of being diagnose with diabetes (pregestational or gestational; 2.4% vs 5.0%; P < .001) or hypertensive disorder of pregnancy (chronic, gestational hypertension or pre-eclampsia; 1.2% vs 5.1%; P < .001) compare with the in-hospital birth group.

“In some previous studies, births that occur in the hospital only after complications arose during a planned home birth were include in the ‘in-hospital’ birth group,” Sheiner said. Nevertheless, the new findings add to substantial evidence of the benefits of delivering in hospital, where life-saving assistance is available, if needed.

According to the American College of Obstetricians and Gynecologists (ACOG), the number of home births in the United States is even lower than that report in the current study, at just less than 1% of all births (0.9%; about 35,000 births per year), and approximately a quarter of those are unplan or unattend.

Critical factors when considering  home birth include proper candidate selection; availability of a certified nurse, midwife or physician; ready access to consultation; and access to safe and timely transport to nearby hospitals in case it is required, ACOG recommends.Ultimately, however, the organization defends women’s right to ultimately choose where to give birth: “Although [ACOG] believes that hospitals and accredited birth centers are the safest settings for birth, each woman has the right to make a medically informed decision about delivery.”