Two new papers shed light on the appalling outcomes at American homebirth.
The first paper is Apgar Score of Zero at Five Minutes and Neonatal Seizures or Serious Neurologic Dysfunction in Relation to Birth Setting by Grunebaum et al.
The authors used CDC data to assess birth outcomes:
Data from the United States Centers for Disease Control’s National Center for Health Statistics birth certificate data files were used to assess deliveries by physicians and midwives in and out of the hospital for the 4-year period from 2007-2010 for singleton term births (≥37 weeks gestation) and ≥2,500 grams. Five-minute Apgar scores of zero and neonatal seizures or serious neurologic dysfunction were analyzed for four groups by birth setting and birth attendant (hospital physician, hospital midwife, free-standing birth center midwife, and home midwife).
They found:
Home births (RR 10.55) and births in free-standing birth centers (RR 3.56) attended by midwives had a significantly higher risk of a 5-minute Apgar score of zero (p<.0001) than hospital births attended by physicians or midwives. Home births (RR 3.80) and births in free-standing birth centers attended by midwives (RR 1.88) had a significantly higher risk of neonatal seizures or serious neurologic dysfunction (p<.0001) than hospital births attended by physicians or midwives. (my emphasis)
In other words, homebirth increases the risk of an Apgar score of zero by nearly 1000%!!
As the authors explain:
There is an identifiable pattern in these data for the outcomes of singleton term births: home birth is associated with a significantly increased risk of 5-minute Apgar score of 0 and neonatal seizures or serious neurologic dysfunction compared to hospital birth. When it comes to home birth versus hospital birth, setting is strongly associated with worse outcomes. The increased rate of adverse outcomes of home births exists despite the reported lower risk profile of home birth.13 The pattern for free-standing birth centers is also identifiable: this setting is associated with increased risk compared to hospital delivery, though not as high risk as home birth. When it comes to freestanding birth center versus hospital, setting is strongly associated with worse outcomes.
It is essential to note that these significantly increased risks of adverse outcomes from the setting of home and from the setting of free-standing birth centers reported here may be serious underestimations of clinical complications. (my emphasis)
The choice of an Apgar score of zero and the primary outcome measurement is particularly apt, since severe neurologic injury is particularly likely at homebirth, because homebirth midwives do not monitor the fetal heart rate appropriately. Hence the inordinate number of babies who drop dead or nearly dead into the hands of clueless homebirth midwives. Babies with a 5 minute Apgar score of zero include those that died intrapartum, but also those that were born without vital signs who were subsequently resuscitated by emergency personnel.
Interestingly the authors chose to use the MD group as the reference group despite the fact that it contains high risk women. I typically use the hospital based midwife as a reference since their are fewer high risk patients. Using that standard, homebirth has a risk of 5 minute Apgar score of zero that is 19X higher than low risk hospital birth!
The authors point out that all practitioner are REQUIRED to disclose this information to women contemplating homebirth, midwives as well as obstetricians.
The second paper is Selected perinatal outcomes associated with planned home births in the United States by Cheng et al.
The authors looked at birth outcomes from the year 2008.
There were 2,081,753 births meeting study criteria. Of these, 12,039 (0.58%) were planned home births. More planned home births had 5-minute Apgar score <4 (0.37%) compared to hospital births (0.24%; aOR 1.87; 95% CI 1.36-2.58) and neonatal seizure (0.06% vs. 0.02% respectively; aOR 3.08; 95% CI 1.44-6.58). Women with planned home birth had fewer interventions, including operative vaginal delivery, and labor induction/augmentation.
This is precisely what you would expect when mothers and midwives shun lifesaving interventions.
I’ve used the CDC Wonder data from 2003-2008 to demonstrate that in each year, planned homebirth with a homebirth midwives has a neonatal death rate anywhere from 3-7X higher than hospital birth. These new papers add valuable information by looking at severe neurologic outcomes as well and showing that such outcomes are much more common at planned homebirth.
I look forward to seeing how Henci Goer, Ina May Gaskin, Jennifer Block and other professional homebirth advocates attempt explain these statistics away. I’m guessing that they will be at a loss, and therefore simply ignore these hideous results.
