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
Retrospective study (Data extracted in 2019)
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
Identification of risks known to increase perinatal morbidity and mortality for intended home births
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
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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