Elsevier

Obstetrics & Gynecology

Volume 100, Issue 2, August 2002, Pages 253-259
Obstetrics & Gynecology

Original research
Outcomes of planned home births in Washington State: 1989–19961

https://doi.org/10.1016/S0029-7844(02)02074-4Get rights and content

Abstract

OBJECTIVE:

To determine whether there was a difference between planned home births and planned hospital births in Washington State with regard to certain adverse infant outcomes (neonatal death, low Apgar score, need for ventilator support) and maternal outcomes (prolonged labor, postpartum bleeding).

METHODS:

We examined birth registry information from Washington State during 1989–1996 on uncomplicated singleton pregnancies of at least 34 weeks’ gestation that either were delivered at home by a health professional (N = 5854) or were transferred to medical facilities after attempted delivery at home (N = 279). These intended home births were compared with births of singletons planned to be born in hospitals (N = 10,593) during the same years.

RESULTS:

Infants of planned home deliveries were at increased risk of neonatal death (adjusted relative risk [RR] 1.99, 95% confidence interval [CI] 1.06, 3.73), and Apgar score no higher than 3 at 5 minutes (RR 2.31, 95% CI 1.29, 4.16). These same relationships remained when the analysis was restricted to pregnancies of at least 37 weeks’ gestation. Among nulliparous women only, these deliveries also were associated with an increased risk of prolonged labor (RR 1.73, 95% CI 1.28, 2.34) and postpartum bleeding (RR 2.76, 95% CI 1.74, 4.36).

CONCLUSION:

This study suggests that planned home births in Washington State during 1989–1996 had greater infant and maternal risks than did hospital births.

Section snippets

Materials and methods

We conducted a population-based cohort study using Washington State birth certificate data from 1989 to 1996. The birth certificate data were linked to the Washington State infant death certificates to identify cases of neonatal death and postneonatal death. Other outcomes such as postpartum bleeding, prolonged labor, neonatal respiratory distress (defined as postdelivery ventilation for more than 30 minutes), and a very low Apgar score (≤3) at 5 minutes were identified through information

Results

Relative to women intending to deliver in hospital, those intending to deliver at home were, on average, older, more likely to be married, white, nonsmokers, and parous (Table 1). They also tended to be more highly educated; however, data on education were not collected for mothers giving birth before 1992 (almost 50% of both of the home birth and hospital birth cohorts). Women intending to deliver at home were slightly less likely to reside in an urban area, to live in King County, to have

Discussion

Although mothers intending to deliver infants at home were more likely to be at least 20 years old, married, nonsmokers, and insured than mothers who delivered in hospitals, planned home births were associated with an elevated risk of neonatal mortality and very low Apgar score at 5 minutes in this study. Planned home births were also associated with increased risk of prolonged labor and postpartum bleeding among nulliparous women. The incidence of neonatal mortality was 3.5 out of 1000 live

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1

We thank the Washington State Department of Health for providing access to birth certificate data, Paul Doria-Rose and Susan Nielson-Searles for their editorial assistance, and William O’Brien from the University of Washington for his computer programming assistance.

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