By Dr. Boris Petrikovsky
A while ago, we had an online discussion on COLlive.com about home births. I enjoyed most of the comments and understand that personal beliefs, not science, are behind them.
Two recent events forced me to return to the same topic.
One, another unfortunate victim of her beliefs: a patient whose postpartum bleeding required the removal of her uterus as well as multiple blood transfusions.
Second, two scientific publications by Dr. Amos Grunebaum et al and Dr. Barry Shields et al. Below, please find direct quotes from the articles.
“There has been an increase in home births in the United States over the last ten years. Recent studied have shown that when compared with hospital births, planned home births by midwives are associated with an increase in adverse neonatal outcomes, such as neonatal deaths, Apgar score of 0, neonatal seizures, or serious neurological dysfunction.
The American College of Obstetricians and Gynecologists (ACOG) and the American Academy of Pediatrics (AAP) have concluded that planned hospital births are safer than planned home births.
Data were abstracted from the US birth certificate database. Because non-identifiable data from a publically available data set were used, this study was not considered human subject research and did not require review by the Institutional Review Board of Weill Medical College of Cornell University.
Between 2010 and 2012, there were a total of 11,905,817 deliveries in the United States. There were 85,318 home births (0.71% of all births in the United States).
The ACOG criteria for home births specifically exclude pregnancies 41 weeks or longer from their home birth eligibility. Post-term pregnancies are associated with multiple, well-known complications, such as labor dystocia, increased perinatal mortality rate, low umbilical artery pH levels at delivery, low 5 minute Apgar scores, post maturity syndrome, fetal distress, cephalo-pelvic disproportion, postpartum hemorrhage, and an increased risk of neonatal within the first year of life.
Selection of patients for home births by countries with midwife organizations, such as the Royal Dutch Organization of Midwives, follows collaborative guidelines with strict protocols for selecting patients for home-births.
It is possible that some pregnant women with risk factors may insist on home births despite the increased risks of adverse outcomes. In circumstances in which home births are contraindicated because of risk factors, physicians and midwives have the professional responsibility to strongly recommend hospital births, to recommend against home births, and to refuse the women’s requests to attend their home births. This is because patients’ requests by themselves do not determine professional responsibility.”
Authors of the second paper stated that:
“Maternal hemorrhage remains a major source of maternal morbidity and death. In the United States, the rate of postpartum hemorrhage has increased steadily; in 2004, 3% of all births were complicated by postpartum hemorrhage. Similar trends have been noted in Canada, Australia, and Europe. The incidence of abnormal placentation also appears to be increasing; in New York State, it is the most common cause of obstetric hemorrhage. “Near miss” events, defined as blood loss of more than or equal to 1,500 mL, occur in approximately 15% of patients who experience postpartum hemorrhage. This suggests that approximately 18,000 women per year in the United States have life-threatening hemorrhages during the course of childbirth.”
Despite the fact that the results of both articles are convincing to the majority of physicians on the risk of home births, it will probably not convince the lay public. Home births have become a sort of religion, where no scientific evidence is strong enough.
Reviewing most of the comments put together by home birth supporters, I can understand the emotional fervor of most of them, except for one, which was written by a doctor who claimed she would like to have a home birth. Doctors should know better and should put the safety of patients above all.
–Boris Petrikovsky is a professor of obstetrics and gynecology and has authored two books and over one hundred research articles. Dr. Petrikovsky delivered over 5,000 babies and performed over 2,000 gynecological surgeries over the past three decades. He is part of the Chabad of Great Neck community where he resides with his wife and children.