Setting Makes Home Deliveries More Risky, Not Midwives

    Childbirth can be an intimidating time in a woman’s life. It’s only natural that she would seek the most comfortable, intimate setting possible to accomplish this miraculous feat.

    Hospitals can be intimidating, too. That’s why some women in the US choose to deliver their children at home, with the assistance of a trusted midwife, rather than in a hospital.

    Midwife and newborn in hospitalMany obstetricians in the US understand a woman’s desire for comfort in familiar settings when a baby is born, but sometimes, unexpected emergencies arise which require immediate medical attention to safeguard the health of the mother or child. In many cases, a midwife working in a private home simply does not have the resources at hand to achieve the optimum outcome in a crisis situation such as this.

    Amos Grunebaum, MD, is a specialist in high-risk pregnancies who advises his patients to invite a midwife into the hospital delivery room so a woman can have both the comfort of a familiar birthing companion and the necessary medical staff and equipment ready to go at a moment’s notice if problems develop. This best-of-both-worlds scenario provides the safest setting for a woman to have a baby in the US, according to Grunebaum, who is a member of the Weill Cornell Physicians system in New York. The safety factor applies to women experiencing normal pregnancies as well as high-risk patients.

    Grunebaum joined the Weill Cornell network 14 years ago after working at St. Luke’s-Roosevelt Hospital Center, also in New York, where he was instrumental in developing an in-house birthing center. “I completely support in-house birthing centers,” says Grunebaum.

    Grunebaum and his colleagues compared the occurrence of neonate (newborn) deaths in midwife-assisted at-home births to midwife-assisted in-hospital births between 2006 and 2009. All the 13,936,071 births under study were non-complicated — no preterm, stillborn, or multiple births; no breech or shoulder presentations; and no congenital abnormalities.

     

    • 91.2% of the deliveries were in-hospital with physicians in attendance
    • 7.87% were in-hospital with midwives in attendance
    • 0.28% occurred in free-standing birthing centers
    • 0.65% were home deliveries
    • 0.44% of the home deliveries were midwife assisted

    A medically classified neonatal death can occur as long as 27 days after delivery. Early neonatal death occurs within the first 6 days. Although the overall death rate in the study was small, the rate was significantly higher for babies born at home:

    • 0.14 early neonate deaths per 1,000 births with in-hospital midwives in attendance
    • 0.93 per 1,000 in-home births with midwife assistance
    • 0.32 per 1,000 total neonate deaths in hospital births with midwives
    • 1.26 per 1,000 in at-home births with midwives

    The death rate for infants born at home was 75% higher than those born in a medical facility:

    • 1 death per 794 home births
    • 1 death per 3,125 hospital births

    Dr. Grunebaum encourages the assistance of in-hospital midwives any time a woman desires it but feels the current medical system in the US makes the midwife-physician collaboration a rarity rather than the norm.

    He would like to see the typical hospital maternity setting become more cozy and inviting for women and their families. If hospital maternity departments were more attractive to the expectant mother, perhaps more of them would choose the safety of the hospital over the comfortable familiarity of home.


    Source: Wickline, Sarah. “Home Births, Not Midwives, Hold Risk for Babies.” MedPage Today. MedPage Today LLC. Feb 10, 2014. Web. Feb 14, 2014.