Study Weighs Pros, Cons of Home or Hospital Birth

More seizures, lower Apgar scores found in home

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Friday, February 10, 2012

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FRIDAY, Feb. 10 (HealthDay News) -- Babies whose mothers choose to deliver at home are at higher risk of complications after birth, including low Apgar scores and seizures, a new study finds.
However, if the home birth was attended by a certified nurse midwife, some of the added risk disappeared.
But only about 26 percent of home births were attended by a certified nurse midwife, according to a new study to be presented Friday at the Maternal-Fetal Medicine Society's annual meeting in Dallas.
"We observed a higher risk of lower Apgar scores and incidence of neonatal seizures in women who had home births," said study author Dr. Yvonne Cheng, an obstetrician/gynecologist at the University of California, San Francisco. "These adverse findings are particularly present when the birth attendant is not a certified nurse midwife."
She added: "The location of birth is important, but who is present at the delivery is more important."
Cheng and her colleagues analyzed birth certificate data on nearly 2.3 million singleton births in 2008 in the United States. About 10,700 women, or less than 1 percent (0.47 percent), delivered in a birthing center, usually a standalone facility staffed by a midwife and in close proximity to a hospital in case of emergency.
About 12,400 women (0.54 percent) gave birth at home intentionally.
The birth certificates included whether it was a doctor, a certified nurse midwife, an "other midwife" or someone else who assisted with the delivery.
There was little difference in outcomes for babies if they were born in a hospital or a birthing center.
The study did find that babies born at home or a birthing center were much less likely to be delivered via Cesarean section; however, researchers said their data are likely not reliable. The reason is that if a mother intended to give birth at home or in a birthing center but ended up being taken to the hospital for a C-section because of complications, the birth certificate would have recorded an in-hospital birth.
Babies born at home were more than twice as likely to have an Apgar score of under 7 as children born in a hospital or at a birthing center, and also had double the chances of having a seizure.
The Apgar score is a test used to measure a child's skin color, pulse and overall vigor in the moments after birth.
The overall number of kids who had seizures was low -- less than 1 percent at any location.
Prior research has shown that babies with lower Apgar scores are more likely to have complications after birth, such as needing breathing assistance, going to the ICU, having seizures or having developmental issues, Cheng said.
Although the numbers are still small, a growing number of women are choosing to give birth outside of hospitals, Cheng said, with the numbers rising about 20 percent between 2004 and 2008.
Those women often want to give birth without painkillers such as epidurals. They want to have "more control" over the birth experience; may feel more comfortable in their own surroundings; or may want to have multiple people in the room when they deliver, something many hospitals limit, added Dr. Mary Norton, director of perinatal research at Stanford University Medical Center.
Yet, women who are choosing home birth should recognize there are risks, Norton said.
"Even in a normal-health woman with a normal pregnancy, there will always be unanticipated things that can happen and unanticipated emergencies," she said.
At home, you are further from medical care. Whereas birthing centers often have systems in place to transfer a woman to a hospital in case of emergency, women at home may have to wait longer for an ambulance, or it may be difficult to move a woman who is in labor onto a gurney and transport her to a hospital.
"This data does indicate there is a higher level of risk to the baby when delivering at home. If someone is carefully monitored, is in close proximity to the hospital and willing to go to the hospital if needed, then the risks are lower," she said.
Because this study was presented at a medical meeting, the data and conclusions should be viewed as preliminary until published in a peer-reviewed journal.

SOURCES: Yvonne W. Cheng, M.D., Ph.D., University of California, San Francisco, obstetrics & gynecology, San Francisco; Mary Norton, M.D., professor, obstetrics and gynecology, and director, perinatal research, Stanford University Medical Center; Feb. 10, 2012, presentation, Society for Maternal-Fetal Medicine annual meeting, Dallas

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