Risk of anoxic brain injury is more than 18 times higher at homebirth


I’ve been struck by the number of stories on this blog of homebirths that ended with the baby receiving cooling therapy. The treatment, known as therapeutic hypothermia, is designed to reduce the brain damage of hypoxic ischemic encephalopathy (HIE) that results when a baby is deprived of oxygen before birth. To my knowledge, no one had looked at the association between homebirth and cooling therapy … until now.

The poster entitled Home birth and risk of neonatal hypoxic ischemic encephalopathy, to be presented at the forthcoming February meeting of the Society of Maternal-Fetal Medicine looks at precisely this issue.

The authors, from Weill Cornell Medical Center, explain:

Since 2007 our institution has been a primary referral center in New York City (NYC) for neonates with suspected HIE that undergo therapeutic hypothermia (cooling). A database of all cooling cases from 2007-2011 at our institution was linked to vital records. Four normal controls per case were then selected from the birth certificate data after matching for year of birth, geographic location (community district), and gestational age in weeks. The odds of HIE for home versus hospital birth was assessed via logistic regression.

What did they find?

Of the 69 infants who received cooling therapy, 5 had been born at homebirth. That represents 7.2% of babies who underwent treatment, an extraordinary number consider that homebirth accounts for only 0.5% of births.


Women who delivered at home had 16.9 times the odds of neonatal HIE compared to women who delivered in a hospital (p <0.01). The odds remained significant after controlling for maternal age, ethnicity, education level, primary payer and prepregnancy weight (aOR 18.7, 95% CI 2.02-172.47). After controlling for mode of delivery the odds of HIE increased for home birth compared to hospital birth (aOR 32.9, 95% CI 3.52-307.45).

In other words, homebirth increased the the odds of a baby needing cooling therapy for brain damage due to lack of oxygen by more than 18 fold!

When compared with babies born vaginally in the hospital, babies born at homebirth had a rate of hypoxic brain damage 32 times higher, suggesting that C-sections dramatically decreased the risk of hypoxic brain injury.

The results are appalling, though hardly surprising. All the existing scientific evidence, as well as state and national statistics shows that American homebirth has an increased risk of death of at least 3-9 times higher than comparable risk hospital birth. Since most of these deaths are due to oxygen deprivation in labor, it is not unexpected that the risk brain damage is also dramatically increased.

This is yet another stunning indictment of American homebirth. Far from being safe, homebirth dramatically increases the risk of brain injury as well as death.