Birth Setting Study Signals Significant Risks in Planned Home Birth

Planned Home Birth
Largest study of its kind finds increased risk of stillbirth, neonatal seizures or serious neurological dysfunction in planned home births

NEW YORK (September 17, 2013) — While the number of homebirths in the United States has grown over the last decade, researchers at New York-Presbyterian/Weill Cornell Medical Center have found that babies born at home are roughly 10 times as likely to be stillborn and almost four times as likely to have neonatal seizures or serious neurologic dysfunction when compared to babies born in hospitals.

The largest study of its kind, which includes data on more than 13 million U.S. births, will appear in the October issue of the American Journal of Obstetrics and Gynecology and is now available online. The risk is associated with the location of a planned birth, rather than the credentials of the person delivering the baby. The study findings showed that the risk of stillbirth is even greater in first-born babies – 14 times the risk of hospital births. “The magnitude of risk associated with home delivery is alarming,” says the study’s lead author, Dr. Amos Grunebaum, chief of labor and delivery at NewYork-Presbyterian/Weill Cornell Medical Center and associate professor of clinical obstetrics and gynecology at Weill Cornell Medical College.

Given the study’s findings, Dr. Grunebaum says obstetric practitioners have an ethical obligation to disclose the risks associated with planned home birth to expectant parents who express an interest in this delivery setting. He says, “Parents-to-be need to know that if they deliver at home, their baby has a greater risk of dying or having a serious neurological problem.”

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It’s all right.

Having your child die at birth is ok, because it happens at home, and is therefore more ‘natural’.

That’s sad :(

But I’m wondering what the causes of these stillbirths are and if they are preventable deaths if the bubs were born in a hospital.

>> roughly 10 times as likely to be stillborn and almost four times as likely to have neonatal seizures or serious neurologic dysfunction when compared to babies born in hospitals<<

I would have expected a stillbirth to be a stillbirth regardless of setting. Perhaps I am naive. If the baby is dead, it’s dead and birthing it in a hospital won’t resurrect it. Unless this is referring to situations where intervention should have been accessed and wasn’t.

“When a complication does arise, what’s needed is access to a team of skilled specialists with the training and technology in place to handle emergency procedures. In a home, none of these options are available.”

So it’s more than just clean sheets and boiling some water then?

Divine Angel said:

“When a complication does arise, what’s needed is access to a team of skilled specialists with the training and technology in place to handle emergency procedures. In a home, none of these options are available.”

So it’s more than just clean sheets and boiling some water then?

Wasn’t the boiling water just some “busy time” for the expectant father?

Skeptic Pete said:

Divine Angel said:

“When a complication does arise, what’s needed is access to a team of skilled specialists with the training and technology in place to handle emergency procedures. In a home, none of these options are available.”

So it’s more than just clean sheets and boiling some water then?

Wasn’t the boiling water just some “busy time” for the expectant father?

Mrs SS says it used to be done for sterilizing

If there is no breathing detected due some complication of labour such as placenta praevia it can be stimulated by driving a needle deep into the end of the nose.

HTH

Mrs SS reckons that this must be the only place in the worldthat this happens… orthe survey results are complete shenannigans

Using unadjusted numbers, you’d expect the hospital deaths to be higher, because anyone with expected complications would be encouraged to have a hospital birth, rather than home.

So I wonder if the numbers have been adjusted to allow for this.

If they were, I wonder if the adjustment was a bit over-enthusiastic.

It is sometimes necessary to insert an arm or two, occasionally up to the shoulder,* to reposition a mal-presentimg foetus.

*bit less for humans

buffy said:

>> roughly 10 times as likely to be stillborn and almost four times as likely to have neonatal seizures or serious neurologic dysfunction when compared to babies born in hospitals<<

I would have expected a stillbirth to be a stillbirth regardless of setting. Perhaps I am naive. If the baby is dead, it’s dead and birthing it in a hospital won’t resurrect it. Unless this is referring to situations where intervention should have been accessed and wasn’t.

Depends on when the baby dies. I can’t recall the numbers OTTOMH, but I was surprised by how many of them died during labour.

In Australian labour wards, the baby’s heartbeat is continually monitored. If it shows signs that it isn’t doing well, it can be out in half an hour in theatre (one of my week of nights, we had a code green every night), or worst case scenario, within minutes in the labour room (I’ve never seen that happen but it’s a possibility). A midwife at a home delivery wouldn’t be able to do that.

OCDC said:

buffy said:

>> roughly 10 times as likely to be stillborn and almost four times as likely to have neonatal seizures or serious neurologic dysfunction when compared to babies born in hospitals<<

I would have expected a stillbirth to be a stillbirth regardless of setting. Perhaps I am naive. If the baby is dead, it’s dead and birthing it in a hospital won’t resurrect it. Unless this is referring to situations where intervention should have been accessed and wasn’t.

Depends on when the baby dies. I can’t recall the numbers OTTOMH, but I was surprised by how many of them died during labour.

In Australian labour wards, the baby’s heartbeat is continually monitored. If it shows signs that it isn’t doing well, it can be out in half an hour in theatre (one of my week of nights, we had a code green every night), or worst case scenario, within minutes in the labour room (I’ve never seen that happen but it’s a possibility). A midwife at a home delivery wouldn’t be able to do that.

yeah, Mrs SS has had some of those..
Midwifes in Aust have a set of guidelines for mothers if they are to do home births (abided my most, with a few very bad exceptions in the last couple of years)
Mrs SS is actually licenced to do home births, but she is pretty experienced in determining the suitability of mothers for incident free births, she has had to call an ambulance on 1 occasion though

A code green is the only time you see people sprinting in the hosp. They’re scary shit.

OCDC said:

A code green is the only time you see people sprinting in the hosp. They’re scary shit.

Must be different over there, in tas it was code blue that everyone races to.
(iirc, i think green was evacuate in the lgh)

stumpy_seahorse said:

OCDC said:

A code green is the only time you see people sprinting in the hosp. They’re scary shit.

Must be different over there, in tas it was code blue that everyone races to.
(iirc, i think green was evacuate in the lgh)

Melb and Kweenzland, blue is an adult or child in cardiac / respiratory arrest. Green is foetal distress / urgent (30 min) caesar. You run to a blue, sprint to a green.

OCDC said:

stumpy_seahorse said:

OCDC said:

A code green is the only time you see people sprinting in the hosp. They’re scary shit.

Must be different over there, in tas it was code blue that everyone races to.
(iirc, i think green was evacuate in the lgh)

Melb and Kweenzland, blue is an adult or child in cardiac / respiratory arrest. Green is foetal distress / urgent (30 min) caesar. You run to a blue, sprint to a green.

ah, cool.
Mrs SS has only midwiferred in tas nsw and sa
(and tenessee and another us state i forget)

OCDC said:

You run to a blue, sprint to a green.

Gee, that makes it sound as if you GAF.

pftfsif

sibeen said:

OCDC said:

You run to a blue, sprint to a green.

Gee, that makes it sound as if you GAF.

OCDC said you sibeen. She didn’t indicate that she does anything.

Years ago having a baby was a very tricky business

Women used to die during labour

It’s like the whole vaccination thing I suppose

The shunning of help and technology to keep yourself alive

mums to home birth have same number checkups etc before the big day?