Home births assisted by midwives carry a risk of neonatal death four times higher than those carried out in a hospital with a midwife present, according to the largest study of its kind.
A neonatal death refers to the death of a liveborn infant within its first 28 days of life.
The study, led by researchers at New York-Presbyterian Weill Cornell Medical Center, looked at nearly 14 million linked infant birth and neonatal death data collected by the Centers for Disease Control and Prevention.
The research indicated that the absolute risk of neonatal mortality was 3.2 per 10,000 births in midwife hospital births, and 12.6 per 10,000 births in midwife home births. For first-time mothers giving birth at home with a midwife, this rate jumped to 21.9 per 10,000 births.
"This risk further increased to about seven-fold if this was the mother's first pregnancy, and to about ten-fold in pregnancies beyond 41 weeks," Dr. Amos Grunebaum said in a statement.
Based on their findings, the researchers emphasize that it's not the midwife's credentials but the setting that affects the baby's mortality risk. They also stressed that physicians have a moral obligation to disclose these risks to patients who express interest in home births and to strongly recommend against it. They should also ensure that any unnecessary obstetric interventions - a main reason for parents opting for home births - are addressed in hospitals.
A study published in the British Medical Journal last year found that home births in the Netherlands, where one-third of births take place at home, resulted in fewer complications and adverse outcomes among second-time mothers with no health risks when compared to planned hospital births - 1 per 1,000 versus 2.3 per 1,000.
"Low risk women in primary care at the onset of labour with planned home birth had lower rates of severe acute maternal morbidity, postpartum haemorrhage, and manual removal of placenta than those with planned hospital birth," the researchers concluded.
