Original ResearchObstetricsPlanned home births: the need for additional contraindications
Section snippets
Study population
This is a population-based, retrospective cohort study of all term (≥37 weeks gestation), normal weight (≥2500 g), singleton, nonanomalous births from 2009–2013, the last 5 years of the available data, in states that used the 2003 revised birth certificate and the Centers for Disease Control and Prevention’s period-linked birth-infant deaths files that allowed for identification of intended and unintended home births. We excluded births if they met any of the following criteria: birthplace
Characteristics
The study population included a total of 12,953,671 singleton, nonanomalous, term (≥37 weeks) deliveries with infants who weighed ≥2500 g who delivered in states that used the 2003 revised birth certificate from 2009–2013 in a hospital or were intended (or planned) home births. Of the whole group, 11,779,659 deliveries (90.9%) were hospital deliveries by physicians; 1,077,197 deliveries (8.3%) were hospital deliveries by certified nurse midwives, and 96,815 deliveries (0.7%) were intended
Comment
The results of our study confirm the findings of other studies that show an increased risk of neonatal death in planned home births.2, 4, 5 We have demonstrated that 2 risk factors, namely first-time and postterm (≥41 weeks) pregnancies, significantly had increased neonatal mortality rates, approaching or exceeding those for planned home birth after cesarean delivery, 1 of the 3 ACOG absolute contraindications for planned home birth.5 Therefore, 2 risk factors (first-time births and births at
References (38)
- et al.
Selected perinatal outcomes associated with planned home births in the United States
Am J Obstet Gynecol
(2013) - et al.
Early and total neonatal mortality in relation to birth setting in the United States, 2006-2009
Am J Obstet Gynecol
(2014) - et al.
Maternal and newborn outcomes in planned home birth vs planned hospital births: a metaanalysis
Am J Obstet Gynecol
(2010) - et al.
Apgar score of 0 at 5 minutes and neonatal seizures or serious neurologic dysfunction in relation to birth setting
Am J Obstet Gynecol
(2013) - et al.
Perinatal risks of planned home births in the United States
Am J Obstet Gynecol
(2015) - et al.
Who is at risk for prolonged and postterm pregnancy?
Am J Obstet Gynecol
(2009) - et al.
Maternal and obstetric complications of pregnancy are associated with increasing gestational age at term
Am J Obstet Gynecol
(2007) - et al.
Influence of parity on fetal mortality in prolonged pregnancy
Eur J Obstet Gynecol Reprod Biol
(2007) - et al.
Late maternal age and postdate pregnancy
Am J Obstet Gynecol
(1989) - et al.
Reliability of Indiana birth certificate data compared to medical records
Ann Epidemiol
(2006)
The reliability and validity of birth certificates
J Obstet Gynecol Neonatal Nurs
Ethics and professional responsibility: Essential dimensions of planned home birth
Semin Perinatol
Planned home birth: the professional responsibility response
Am J Obstet Gynecol
Out-of-hospital births in the United States 2009-2014
J Perinat Med
Committee Opinion No. 669: Planned home birth
Obstet Gynecol
Outcomes of care for 16,924 planned home births in the United States: the Midwives Alliance of North America Statistics Project, 2004 to 2009
J Midwifery Womens Health
Planned home VBAC in the United States, 2004-2009: outcomes, maternity care practices, and implications for shared decision making
Birth
Planned out-of-hospital birth and birth outcomes
N Engl J Med
Underlying causes of neonatal deaths in term singleton pregnancies: home births versus hospital births in the United States
J Perinat Med
Cited by (18)
The impact of birth settings on pregnancy outcomes in the United States
2023, American Journal of Obstetrics and GynecologyHome births: A growing phenomenon with potential risks
2020, Anales de PediatriaMost Intended Home Births in the United States Are Not Low Risk: 2016−2018
2020, American Journal of Obstetrics and GynecologyCritical appraisal of the proposed defenses for planned home birth
2019, American Journal of Obstetrics and GynecologyCitation Excerpt :Midwives with less training have worse outcomes.22 In addition, planned home births continue to include patients at significantly increased risks;23 anesthesia and surgery are not available at planned home births, and access to them requires time-consuming transport that does not exist in the hospital setting. We have identified at least 8 valid clinical analogies to other very low-absolute-risk clinical situations and their implications that defenses of planned birth have not identified These highly clinically relevant analogies concern the application of the commitment to patient safety at the population level to situations in which absolute mortality risks are far lower than the absolute risk of neonatal death of planned home births but are nonetheless considered unacceptable because reducing variation results in improved outcomes.
Effect of Maternal and Pregnancy Risk Factors on Early Neonatal Death in Planned Home Births Delivering at Home
2018, Journal of Obstetrics and Gynaecology CanadaCitation Excerpt :Previous studies consisting of comparisons among home birth patients similarly noted elevated early neonatal death in breech deliveries, but neonatal death risk estimates failed to reach statistical significance for post-date pregnancies, twin gestations, nulliparous birth, and births of women who had a prior CS.11,12 A recent U.S. study examined risk factors for neonatal death in planned home births versus hospital births.9 Similar to our study, these investigators found that nulliparity and GA ≥41 weeks were associated with increased neonatal death in home births compared with hospital births.
Determinants of Place of Delivery during the COVID-19 Pandemic—Internet Survey in Polish Pregnant Women
2022, Medicina (Lithuania)
The authors report no conflict of interest.
Cite this article as: Grünebaum A, McCullough LB, Sapra KJ, et al. Planned home births: the need for additional contraindications. Am J Obstet Gynecol 2017;216:401.e1-8.