New Cornell study shows homebirth has 4X higher death rate than comparable risk hospital birth

The hits (to the safety of homebirth) just keep on coming.

The latest study, to be presented this Friday in New Orleans at the annual meeting of the Society for Maternal-Fetal Medicine, is titled Term neonatal deaths resulting from home births: an increasing trend.

The study was performed by analyzing CDC data, in exactly the same way that I have been analyzing it for the past 5 years. In this case, the authors chose to remove congenital anomalies as well.

There were a total of 10,453,778 term deliveries between 2007 and 2009 which met study criteria: 9,526,450 (91.13%) were by hospital physicians, 826,543 (7.91%) by hospital midwives, 30,415 (0.29%) by midwives in freestanding birthing centers, 48,202 (0.46%) by midwives at home, and 22,168 (0.21%) by others at home. NNM for those delivered at home by others and by midwives, and those delivered in a freestanding birthing center was significantly higher than those delivered by midwives in the hospital: hospital midwives: 3.1/10,000 (RR:1); home others: 18.2/10,000 (RR: 5.87; 95%CI: 4.21-8.19), home midwives: 13.2/10,000; (RR: 4.32 95%CI: 3.29-5.68), freestanding birthing center: 6.3/10,000;(RR: 2.03; 95%CI: 1.28-3.24)…

Hospital vs Out of Hospital Death Rates

Amos Grunebaum, the lead author, was interviewed by Live Science:

For first time mothers, midwife-attended home births had even worse outcomes: 21.9 babies died for every 10,000 births. Risks also increased for older women, and women who were at 41 weeks of pregnancy, meaning they were more than a week past their due-date, Grunebaum said…

Unlike in the Netherlands, where all home birth attendants are professionally trained, home birth attendants in the United States may be inadequately trained, Grunebaum said.

In addition, home birth attendants in the United States don’t have firm criteria limiting which patients they should see, and so they may attend deliveries for high-risk pregnancies.

“They take twins, they take women who have prior C-sections, they do home deliveries in breech babies,” Grunebaum told LiveScience.

But even when looking at low-risk patients, home births are riskier, Grunebaum said. That’s because even a simple, uncomplicated birth can turn into an emergency very quickly.

“When the baby is in trouble, you have literally minutes to deliver this baby,” Grunebuam said. “There’s no time to transfer the patient from the home to the hospital in sufficient time.”

Women who want fewer medical interventions during labor or delivery, but still lower the risks for their babies should consider having trained midwives attend their births in a hospital, Grunebaum said.

It is important to understand that this study includes only PLANNED homebirths, and UNDERCOUNTS the actual risk of death at homebirth in 3 separate ways:

  1. Transfers to the hospital during attempted homebirth ended up in the hospital group and were not counted in the homebirth death rate.
  2. Intrapartum stillbirths are not included in this data, so homebirth deaths are undercounted even further.
  3. The authors of this study looked at all races, but white women account for more than 90% of women choosing homebirth, and the neonatal death rate for white women is much lower than that for all races.

Once again, we find that the dramatic increased risk of death at US homebirth is a remarkably robust finding. No matter where you look, whether it’s at state data like that of Oregon (9X higher), CDC data or even MANA’s own database (5.5X higher), midwife attended homebirth has a risk of neonatal or perinatal death anywhere from 3-9X higher than hospital birth.