Are Planned Home Births Really Low Risk?

Abstract

INTRODUCTION: Statements by the American College of Obstetricians and Gynecologists and the American Academy of Pediatrics recommend that only low-risk mothers consider a home birth. The goal of this study was to conduct a comparison of risk profiles for planned home births compared with hospital births. METHODS: This study analyzed births from 2009 to 2010 U.S. birth certificate data in the Centers for Disease Control and Prevention National Vital Statistics database. Hospital births and home births by midwife were analyzed on 12 high-risk aspects: advanced maternal age, multiple gestation, preterm, postterm, low birth weight, macrosomia, nulliparity, precipitous labor, breech presentation, premature rupture of membranes, prolonged labor, and prior cesarean delivery. RESULTS: The study population consisted of 8,076,257 deliveries (8,038,365 in a hospital and 37,892 by midwives at home). Midwife home births compared with hospital births had a significantly higher prevalence of five risk factors: advanced maternal age (21.7% compared with 14.3%; odds ratio [OR] 1.66, 95% confidence interval [CI] 1.6–1.7), postterm (27.8% compared with 13.6%; OR 2.43, 95% CI 2.4–2.5), macrosomia (20.5% compared with 7.5%; OR 3.4, 95% CI 3.3–3.5), precipitous labor (7.8 compared with 2.3%; OR 3.8, 95% CI 3.7–3.9), and prolonged labor (3.1% compared with 1.2%; OR 2.9, 95% CI 2.7–3.1) and a high prevalence of three additional risk factors: prior cesarean delivery (4.3%), nulliparity (19.7%), and preterm births (2.3%). CONCLUSION: A significant number of high-risk pregnancies was delivered at home across all analyzed risk factors. Six high-risk pregnancy conditions associated with increased adverse outcomes had a higher prevalence in planned home births than in hospital births (advanced maternal age, postdates, macrosomia, premature rupture of membranes, and precipitous and prolonged labor), whereas three others (prior cesarean delivery, nullipara, preterm births) had a high prevalence.