Alternative birthing ways: the neonatologist's point of view

Abstract

A recent Cochrane review [1] showed that “there is no strong evidence from randomised trials to favour either planned hospital birth or planned home birth for low-risk pregnant women”. However, in this review only one trial (involving 11 women) contributed data. This did not allow conclusions to be drawn about safety. More information emerges from another recent review [2] that assessed babies’ mortality differences between home birth and hospital birth in studies published between 1996 and 2011; they selected 11 studies, with no evidence of an increase of deaths in either group. However, these studies only included low-obstetrical-risk women from western countries. A wide metaanalysis [3] considered all studies in this field published in 1947–2010 (Table 1); 12 studies were retrieved and their conclusions were that, though perinatal mortality was similar between the two groups, “the overall neonatal death rate was almost twice as high in planned home vs planned hospital births, and almost tripled among nonanomalous neonates”. On these bases, the American college of obstetricians and gynecologists [4] affirmed that “reports suggesting that planned home births are safe involved only healthy pregnant women. Recent cohort studies reporting lower perinatal mortality rates with planned home birth describe the use of strict selection criteria for appropriate candidates (. . .). Failure to adhere to such criteria (because of postterm pregnancy, twins, or breech presentation) is clearly associated with a higher risk of perinatal death”. And added: “Another factor influencing the safety of planned home birth is the availability of safe and timely intrapartum transfer of the laboring patient”. The American Academy of Pediatrics agreed with this statement adding: “Geography also may adversely affect the safety of planned home birth, because travel times >20 minutes have been associated with increased risk of adverse neonatal outcomes, including mortality”. AAP requires for these babies the same guarantees given to hospital births, with regard to birth assessment and resuscitation, due