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Home births riskier, new study finds
It is to date the most important comparative study, in terms of sample, carried out on deliveries in hospital and at home. It concludes that there is a much higher risk for the child in the event of a home birth. The opposite results to those obtained during previous, and numerous, data compilations. The main author of this work provides some details.
The study was performed by doctors and researchers at New York-Presbyterian / Weill Cornell Medical Center. It is due for publication in October in the American Journal of Gynecology and Obstetrics. It will spark debate (this is already the case on Parents.fr where a news brief provoked virulent comments) because its conclusions go against the results obtained by previous research. His subject ? Home births (DAA), planned and not unexpected. His particuliarity ? It would be the largest study of its kind to date. Its cohort is indeed impressive: more than 13 million births occurred in the United States between 2007 and 2010. Of these, 67429 took place at home. The researchers conclude that these planned home births would be ten times more risky, in terms of infant mortality, than hospital births. This risk would be 14 times higher for a first child. They also suggest an increased risk of neurological disorders.
Dealing with unexpected complications
The authors insist: for them, it is the place that explains this differential and not the qualification of the professional present. “Giving birth at home is more dangerous, whether the birth takes place in the presence of a doctor or a midwife, assures Dr Amos Grunebaum, main author of this study. Unexpected complications can arise that only a structure equipped with trained personnel accustomed to working as a team can cope. ” A previous study, a meta-analysis this time, published in 2010, still in the American Journal of Gynecology and Obstetrics, concluded at a risk of mortality multiplied by 3. It had been strongly criticized by the scientific community because of several methodological biases.
Midwifery training and prevention at the heart of the debate
Most of the studies (very well compiled on the site of the Collective Interassociative around Birth) carried out on the subject do not show a convincing difference between home deliveries and hospital deliveries. Some even tip the scales in favor of DAAs, such as this Dutch study published by the British Medical Journal in June 2013, which showed a lower rate of delivery bleeding and maternal mortality during home births. For Dr Grunebaum, the cohorts studied are not large enough and it would be the specificity of his study to count a large number of cases. The greater the number of cases observed, the more meaningful the statistical risk. The Netherlands nonetheless remains an interesting example since 20 to 25% of births take place at home and the studies therefore focus on sufficiently large cohorts, without however highlighting specific problems linked to home births. (see the survey published in obstetrics and Gynecology, vol 118, Nov 2011). One downside, however, the Netherlands must face a very average perinatal rate (last peristat survey) which can only be partially explained by the older age of the mothers. According to Dr Grunebaum, it is obvious that “the training of Dutch midwives, their ability to select low-risk women upstream, the good integration of their work within the hospital and the small size of the country, contribute to much better results ”. In the United States, liberal midwives are less trained and little integrated into care networks.
Very opposed to home births because of the results obtained at the end of his research work, the doctor says, on the other hand, is in favor of birthing centers, provided they are hospital., that is to say adjoining a maternity ward. “Anything far from a hospital would play with the baby’s life just to make the mother happy. However, this mother would be the first to be affected if her baby was in pain. This system is being tested in France, but almost on the sly. The bill officially launching the experimentation of these hospital birth centers was adopted by the Senate in June and should soon be examined by the National Assembly.