Still, the current study found that the type of midwife was not the determining factor for infant mortality rates. Rather the location - home versus hospital - was key. Compared to the 3. With non-certified midwives, mortality for babies born in planned home births was Grunebaum says the lack of attendants at a home birth make it harder to monitor labor adequately and care for a newborn at risk of complications like asphyxia, or lack of breathing.
However, these data may not be generalizable to many birth settings in the United States where such integrated services are lacking. For the same reasons, clinical guidelines for the intrapartum care of women in the United States that are based on these results and are supportive of planned home birth for low-risk term pregnancies also may not currently be generalizable Furthermore, no studies are of sufficient size to compare maternal mortality between planned home and hospital birth and few, when considered alone, are large enough to compare perinatal and neonatal mortality rates.
Despite these limitations, when viewed collectively, recent reports clarify a number of important issues regarding the maternal and newborn outcomes of planned home birth when compared with planned hospital births. Women planning a home birth may do so for a number of reasons, often out of a desire to avoid medical interventions and the hospital atmosphere Recent studies have found that when compared with planned hospital births, planned home births are associated with fewer maternal interventions, including labor induction or augmentation, regional analgesia, electronic fetal heart rate monitoring, episiotomy, operative vaginal delivery, and cesarean delivery Table 1.
Planned home births also are associated with fewer vaginal, perineal, and third-degree or fourth-degree lacerations and less maternal infectious morbidity 18 27 31 These observations may reflect fewer obstetric risk factors among women planning home births compared with those planning hospital births. Parous women comprise a larger proportion of those planning out-of-hospital births 27 Compared with nulliparous women, parous women collectively experience significantly lower rates of obstetric intervention, maternal morbidity, and neonatal morbidity and mortality, regardless of birth location.
Those planning home births also are more likely to deliver in that setting than nulliparous women 15 27 For these reasons, recommendations regarding the intrapartum care of healthy nulliparous and parous women may differ outside of the United States Also, proportionately more home births are attended by midwives than planned hospital births, and randomized trials show that midwife-led care is associated with fewer intrapartum interventions Strict criteria are necessary to guide selection of appropriate candidates for planned home birth.
In the United States, for example, where selection criteria may not be applied broadly, intrapartum 1. Additional evidence from the United States shows that planned home birth of a breech-presenting fetus is associated with an intrapartum mortality rate of United States data limited to singleton-term pregnancies demonstrate a higher risk of 5-minute Apgar scores less than 7, less than 4, and 0; perinatal death; and neonatal seizures with planned home birth, although the absolute risks remain low Table 2 17 18 Although patients with one prior cesarean delivery were considered candidates for home birth in two Canadian studies, details of the outcomes specific to patients attempting home vaginal birth after cesarean delivery were not provided 24 In England, women planning a home trial of labor after cesarean delivery TOLAC exhibited fewer obstetric risk factors, were more likely to deliver vaginally, and experienced similar maternal and perinatal outcomes compared with those planning an in-hospital TOLAC In contrast, a recent U.
This observation is of particular concern in light of the increasing number of home vaginal births after cesarean delivery Because of the risks associated with TOLAC, and specifically considering that uterine rupture and other complications may be unpredictable, the College recommends that TOLAC be undertaken in facilities with trained staff and the ability to begin an emergency cesarean delivery within a time interval that best incorporates maternal and fetal risks and benefits with the provision of emergency care.
The decision to offer and pursue TOLAC in a setting in which the option of immediate cesarean delivery is more limited should be considered carefully by patients and their health care providers. In such situations, the best alternative may be to refer patients to facilities with available resources. Health care providers and insurers should do all they can to facilitate transfer of care or comanagement in support of a desired TOLAC, and such plans should be initiated early in the course of antenatal care Recent cohort studies reporting comparable perinatal mortality rates among planned home and hospital births describe the use of strict selection criteria for appropriate candidates 23 24 These criteria include the absence of any preexisting maternal disease, the absence of significant disease arising during the pregnancy, a singleton fetus, a cephalic presentation, gestational age greater than 36—37 completed weeks and less than 41—42 completed weeks of pregnancy, labor that is spontaneous or induced as an outpatient, and that the patient has not been transferred from another referring hospital.
In the absence of such criteria, planned home birth is clearly associated with a higher risk of perinatal death 15 26 Another factor influencing the safety of planned home birth is the availability of safe and timely intrapartum transfer of the laboring patient. Most of these intrapartum transports are for lack of progress in labor, nonreassuring fetal status, need for pain relief, hypertension, bleeding, and fetal malposition 27 41 The relatively low perinatal and newborn mortality rates reported for planned home births from Ontario, British Columbia, and the Netherlands were from highly integrated health care systems with established criteria and provisions for emergency intrapartum transport 23 24 Cohort studies conducted in areas without such integrated systems and those where the receiving hospital may be remote, with the potential for delayed or prolonged intrapartum transport, generally report higher rates of intrapartum and neonatal death 6 9 11 15 If a baby is born at home and requires immediate medical attention, one should consider how long it may take for first responders to arrive.
Unassisted childbirth is legal in every state in the United States and pregnant people are not required to give birth in hospitals or birthing centers. However, with the power to choose comes the responsibility of weighing risks and benefits and many birth professionals believe unassisted birth is a risk not worth taking.
There have also been cases where mothers are prosecuted, sometimes for murder , after delivering stillborn babies at home. Even though the risks are there, there are steps pregnant people can and should take to ensure their home birth is as safe as possible for both parent and baby. Planning your birth close to a hospital so that help is nearby if complications arise, instead of attempting to give birth an hour from the nearest medical facility is an important first step in the planning process.
Also, taking classes in neonatal resuscitation prior to the birth event should be considered a primary point in preparing for an unassisted birth. Understanding the stages of labor , what each feels like and indicates is also important. Being aware of how the body works during labor and what should be expected is a major step in prepping for an unassisted birth. Research and education are of paramount importance and ample resources are available online.
Prenatal care with a nurse-midwife or OB are also not off the table even though you choose an unassisted birth. Seeing a certified medical professional over the course of the pregnancy is a vital step in ensuring the safety of everyone involved.
By Kristi Pahr July 01, Save Pin FB More. Comments 1. Sort by: Newest.
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