An immutable truth: planned home births in the United States result in avoidable adverse neonatal outcomes





Objective


Home births in the United States are associated with increased patient-risk profiles, neonatal injury, and death. Recently, research was published that showed that home births in the State of Washington have no increased adverse perinatal outcome. This study aimed to evaluate the risk profiles and outcomes for US planned home births for the years 2016 to 2020.


Study Design


This was a retrospective population-based cohort study that used the Centers for Disease Control and Prevention WONDER online natality online database for the years 2016 to 2020. We included planned home births and compared the outcomes with and without certain risk factors, including breech presentations, twin deliveries, previous cesarean deliveries, deliveries at ≥42 weeks’ gestation, nulliparity, and a composite of at least 1 risk factor: diabetes mellitus (prepregnancy or gestational), hypertension (prepregnancy or gestational), eclampsia, previous preterm births, pregnancies that resulted from infertility treatment, and mothers that had a previous cesarean delivery. Adverse neonatal outcomes included 5-minute Apgar scores of 0 to 3, infant mortalities, seizures, and infant transfers. Statistical analysis included chi-square testing and was displayed as odds ratios (ORs) and 95% confidence intervals (CIs).


Results


A total of 18,954,274 births was investigated between 2016 and 2020, of which 153,123 were planned home births (0.81%) that accounted for the study population. The Table shows the risk factors and outcomes. Most deliveries with risk factors had significantly higher odds of adverse outcomes compared with those with no risk factors. The highest odds were for births with breech presentations and twin deliveries. Deliveries with breech presentations had an OR of 8.88 (95% CI, 7.7–10.3), and deliveries with twins had an OR of 2.8 (95% CI, 2.2–3.4) for at least 1 abnormal outcome. Moreover, the ORs for births with breech presentations with a 5-minute Apgar score of 0 to 3 (which according to the American College of Obstetricians and Gynecologists may be one of the first indications of encephalopathy and confers an increased relative risk of cerebral palsy), infant mortalities, and infant seizures were 16.10 (95% CI, 12.1–21.4), 14.12 (95% CI, 9.7–20.5), and 16.16 (95% CI, 8.6–20.3), respectively.



Table

Risks and outcomes of intended home births in the United States (2016–2020)























































































































































Risks 5-min Apgar of 0–3 Infant mortality Infant seizure Infant transport At least 1 abnormal condition a
No risk factor (n=139,870) 3.09 (432) 1.42 (199) 0.64 (90) 14.95 (2089) 32.24 (4509)
At least 1 risk b (n=12,103) 4.05 (49) 2.48 (30) 0.91 (11) 23.80 (288) 58.58 (709)
OR (95% CI) 1.31 (0.99–1.76) 1.75 (1.19–2.56) 1.41 (0.76–2.65) 1.61 (1.40–1.80) 1.82 (1.70–2.10)
No breech (n=151,169) 2.95 (446) 1.94 (294) 0.61 (92) 15.15 (2290) 33.14 (5010)
Breech (n=1209) 45.49 (55) 25.64 (31) 9.10 (11) 93.47 (113) 196.00 (237)
OR (95% CI) 16.10 (12.10–21.40) 14.12 (9.70–20.50) 16.16 (8.60–20.30) 7.31 (6.00–8.90) 8.88 (7.70–10.30)
No previous cesarean delivery (n=145,330) 3.19 (463) 1.41 (205) 0.63 (92) 15.35 (2231) 33.46 (4863)
Previous cesarean delivery (n=6643) 5.72 (38) 3.61 (24) 1.35 (9) 21.98 (146) 53.44 (355)
OR (95% CI) 1.80 (1.30–2.50) 2.57 (1.70–3.90) 2.15 (1.09–4.27) 1.45 (1.22–1.71) 1.65 (1.50–1.80)
No twins (n=151,914) 3.23 (491) 1.44 (219) 0.65 (98) 15.36 (2333) 33.89 (5148)
Twins (n=1205) 10.79 (13) 11.62 (14) 4.15 (5) 58.09 (70) 82.16 (99)
OR (95% CI) 2.36 (2.90–5.80) 8.20 (4.80–14.10) 6.57 (2.70–16.20) 4.00 (3.20–5.20) 2.80 (2.20–3.40)
Gestational age at 37–41 wk (n=144,723) 2.96 (428) 1.10 (159) 0.64 (920) 14.45 (2091) 32.75 (4740)
Gestational age at <37 wk (n=1457) 24.71 (36) 31.57 (46) 2.75 (4) 137.27 (200) 161.98 (236)
OR (95% CI) 8.54 (6.10–12.10) 29.60 (12.10–41.30) 4.30 (1.60–11.80) 10.85 (9.30–12.70) 5.71 (5.00–6.60)
Gestational age at >42 wk (n=5522) 5.43 (30) 2.35 (13) 0.91 (5) 15.76 (87) 45.64 (252)
OR (95% CI) 1.84 (1.30–2.70) 2.12 (1.20–3.80) 1.44 (0.60–3.50) 1.10 (0.90–1.40) 1.45 (1.30–1.70)
Multiple pregnancy (n=123,853) 2.96 (367) 1.24 (154) 0.52 (64) 13.46 (1667) 30.84 (3820)
Nulliparous (n=26,556) 4.97 (132) 2.37 (63) 1.43 (38) 26.47 (703) 51.62 (1371)
OR (95% CI) 1.68 (1.40–2.10) 1.90 (1.40–2.60) 2.80 (1.90–4.10) 2.00 (1.80–2.20) 1.71 (1.60–1.80)

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Feb 23, 2022 | Posted by in OBSTETRICS | Comments Off on An immutable truth: planned home births in the United States result in avoidable adverse neonatal outcomes
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