Thursday, September 19, 2013

Is the risk of Stillbirth higher with home births vs. hospital births ?

According to the October issue of the American Journal of Obstetrics and Gynecology, the risk of stillbirth is 10 times higher for homebirths.


Researchers at New York-Presbyterian Hospital and Weill Cornell Medical Center, who analyzed data on more than 13 million US births. It is the largest study of its kind, the study's results were confirmed by analyzing birth certificate files from the National Center for Health Statistics to evaluate deliveries by physicians and midwives in the hospital and at home from 2007 to 2010.

The primary outcome measure was the Apgar score: Appearance, Pulse, Grimace, Activity, and Respiration. The researchers looked at Apgar scores of 0, neonatal seizures and neurological dysfunctions. The Apgar test is a screening assessment that quickly studies the health of a baby 1 minute and 5 minutes after being born. If a baby has a 5-minute Apgar score of 0, it is considered stillborn, but the researchers say that 10% of these babies survive.


The Apgar test is usually given to a baby twice: once at 1 minute after birth, and again at 5 minutes after birth. Sometimes, if there are concerns about the baby's condition or the score at 5 minutes is low, the test may be scored for a third time at 10 minutes after birth.
Five factors are used to evaluate the baby's condition and each factor is scored on a scale of 0 to 2, with 2 being the best score:
  1. appearance (skin coloration)
  2. pulse (heart rate)
  3. grimace response (medically known as "reflex irritability")
  4. activity and muscle tone
  5. respiration (breathing rate and effort)
Doctors, midwives, or nurses add these five factors together to calculate the Apgar score. Scores obtainable are between 10 and 0, with 10 being the highest possible score.

RESULTS:

- Babies born at home were nearly 10 times more likely to be stillborn.
- The risk of stillbirth increased to 14 times for firstborns.
- Babies born at home were also almost 4 times more likely to experience neonatal seizures or         serious neurologic dysfunction compared with babies born in hospitals. 

The study associated risk with the location of a planned birth, rather than the credentials of the person delivering the baby. When a child is born at home, typically there is only the midwife or doctor to address any unpredictable circumstances that arise, but in the hospital, a team of specialists can be mobilized in seconds if needed. Also excluded from the study were so called "taxi-cab" births where no Doctor, mid-wife or specialist was available, premature or multiple births, prenatal care and the effect of insured vs. uninsured mothers having home births due to cost.

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