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The Claim: Home-Births Double the Risk of Infant Mortality

Home births and risks

The home birth safety debate

Earlier this year, the American Congress of Obstetricians and Gynecologists told us that babies born at home are two to three times as likely to die in the first month of life than hospital-born babies.

The backup for that claim (one that has been hotly debated): a meta-analysis (an accumulated review of multiple studies) last year in the American Journal of Obstetrics & Gynecology. That review — headed by a specialist in maternal fetal medicine at the Maine Medical Center in Portland — looked at 12 studies on home birth and found that babies born at home without birth defects were more likely to die within 28 days.

This month, the journal Nature breaks down some of the claims and criticism to the original research. Here’s the latest in the home-birth safety debate:

One of the biggest criticisms to the original research is that it excluded data unnecessarily. Of the 12 studies examined, the researchers only used data from a subset of four. One of the omissions was a large Dutch study of 300,000 women that found no increased risk of death in the first week of life.

Epidemiologists also take issue with the fact that the original paper combined studies without measuring the variation in methods and outcomes between the studies.

Recently, at the request of the publisher, the study author posted more of his original data (the journal was officially investigating the validity of his findings after they drew so much criticism). The data changed a bit, but the author drew the same conclusions: a higher risk of mortality for home-birth.

The perspective of the ACOG that home birth carries risks isn’t likely to change, but the scientific basis is clearly up for debate. And with their statement earlier this year, the ACOG also wrote that, “women who decide to deliver at home should be offered standard components of prenatal care, including Group B Strep screening and treatment, genetic screening, and HIV screening.” In other words, they acknowledge a woman’s right to choose this path (at least that’s the way I take it).

As Ceridwen Morris – a trusted, well-informed and rational voice on the topic of childbirth – writes on the debate “It is my belief that home birth safety absolutely must be considered in light of each woman’s personal health, care and circumstances.” This seems like a really important point, because the risks of complication depends so heavily on each woman’s individual health, pregnancy, and support — a nuance that a meta-analysis will not detect.

If you feel somewhere in between the natural and medical birthing camps, earlier this month, Ceridwen wrote a truly helpful post about harnessing the lessons of home birth even when you’re in the hospital.

What’s your take on the home-birth safety debate?

Image: flick

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