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Grand Rounds

Are Home Births Really Low Risk?

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BACKGROUND AND PURPOSE:

  • Home births are intended to be restricted to low-risk patients
  • Grünebaum et al. (AJOG, 2019) assessed what proportion of home births in the US are low vs high risk

METHODS:

  • Retrospective study (Data extracted in 2019)
  • Data sources
    • United States Department of Health and Human Services (US DHHS) | CDC | National Center for Health Statistics (NCHS) | Division of Vital Statistics | Natality public-use data 2016-2018, on CDC WONDER Online Database
  • Study design
    • Identification of risks known to increase perinatal morbidity and mortality for intended home births

RESULTS:

  • This study found that of the intended home deliveries
    • 4.2% had prior cesarean deliveries
    • 23.4% were births to mothers who were ≥35 years old
    • 4.7% were births to mothers 40 years and older
    • 21.5% were ≥41 weeks gestational age
    • 3.6% were ≥42 weeks gestational age
    • 17.4% were nulliparous
    • 7.5% were grand multiparas
    • 12.6% were obese

CONCLUSION:

  • Many intended home births involved pregnancies with ≥1 risk factors that can increase risk for adverse outcomes
  • The authors conclude that more than 60% of all intended home births in the US are not low risk and that

Invoking patient autonomy as the basis for including high-risk patients at planned home births is unprofessional. Professionalism for birth attendants at planned home births requires establishing and following guidelines that define low-risk pregnancies for intended home births and recommending against high-risk intended home births.

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Learn More – Primary Sources:

Most Intended Home Births in the US Are Not Low Risk: 2016-2018

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