According to research published in the October 2013 edition of the American Journal of Obstetrics and Gynecology, women seeking to give birth outside of the hospital should be warned of increased risk of low APGAR scores and increased risk of seizures. The study, which collected data from the Centers for Disease Control (CDC), specifically the National Center for Health Statistics, reviewed birth certificate files from 2007 to 2010. In-hospital births (physician and midwife) were compared to out-of-hospital births (birth center midwife and home midwife).
Researchers gathered all birth records and pulled files reporting 5-minute APGAR scores of 0, seizures and/or severe neurological dysfunction. The resulting files were then separated into one of four categories: hospital physician birth, hospital midwife birth, free-standing birth center midwife birth, and home midwife birth. Categories were chosen based on CDC categories.
The total study population was nearly 13.9 million live births. Nearly 99% of states reported 5-minute APGAR scores and nearly 98% of the states reporting 5-minute APGAR scores also reported seizures and severe neurological dysfunction. The majority of births took place in a hospital setting with a physician (91.16%) followed by hospital setting with a midwife (8.05%), home setting with a midwife (0.49%) and free-standing birth center with a midwife (0.30%). Hispanic women with other children were more likely to choose home midwife births than any other sector of the study population.
When 5-minute APGAR scores were placed in relevant birth setting and attendant categories, a clear risk was immediately recognized for home births and free-standing birthing center births. Home births reported 5-minute APGAR scores of 0 in 1.63% of births. Free-standing birth centers reported 5-minute APGAR scores of 0 in 0.55% of births. Both hospital settings reported significantly lower risks of APGAR scores of 0 at 5-minutes. Risk of seizures also increased with home births and births at free-standing birth centers.
Conclusion: When patients express interest in home birth or births at free-standing birth centers, they need to be educated on the increased risk of low APGAR scores and seizures. Physicians may find it helpful to inquire about why the patient is interested in home birth or free-standing birthing center locations while reinforcing relationships with patients to encourage safe, maternal and fetal care.
Source: Amos Grünebaum, MD, Laurence B. McCullough, Ph.D., Katherine J. Sapra, MPH, Robert L. Brent, MD, Ph.D., DSc (Hon), Malcolm I. Levene, MD, FRCP, FRCPH, FMedSc, Birgit Arabin, MD, Frank A. Chervenak, MD. Apgar score of 0 at 5 minutes and neonatal seizures or serious neurologic dysfunction in relation to birth setting. American Journal of Obstetrics & Gynecology. Volume 209, Issue 4, Pages 323.e1-323.e6, October 2013Doi:10.1016/j.ajog.2013.06.025.
