By Tamara Mathias

(Reuters Health) – Newborns in the U.S. are much more likely to survive a hospital delivery than a planned home birth, regardless of how qualified the attending midwife may be, a new study suggests.

Researchers looked at mortality rates within 30 days of birth for newborns who were delivered by midwives, either at home or in a hospital, between 2010 and 2017.

Dr. Amos Grunebaum and colleagues found that on average, nearly 14 newborns per 10,000 live births died following planned home births – more than four times the rate for babies born in hospitals.

“We were concerned about the rise in U.S. home births and the concomitant increase in neonatal deaths,” said Grunebaum, an obstetrician and gynecologist at Lenox Hill Hospital in New York City. “We wanted to ensure that women who were interested in a planned home birth receive the best and most updated information so they can make informed decisions.”

The discrepancy between survival rates for home and hospital births in the U.S. is not seen in developed nations like England, the Netherlands, Germany and Australia.

These countries tend to screen expectant mothers for risk factors like age or obesity that might endanger their newborns if they opt for a home birth, the authors note in the American Journal of Obstetrics & Gynecology.

“In other high-income countries with established midwifery systems, home birth midwives are well integrated into the health care system. This is not true of the United States,” study authors write.

In an earlier study, Grunebaum’s team found most U.S. planned home births involve women with risk factors like older age, prior cesarean delivery or obesity that would disqualify them for home birth in countries that do have such guidelines.

Most midwives who oversee home births in the U.S. work without a license that meets standards set by the International Confederation of Midwives’ Global Standards for Midwifery Education.

Hospital-certified nurse-midwives, however, hold university degrees in midwifery and receive rigorous training to diagnose and manage complications.

Still, the current study found that the type of midwife was not the determining factor for infant mortality rates. Rather the location – home versus hospital – was key.

Compared to the 3.27/10,000 mortality rate when certified nurse-midwives attended hospital deliveries, mortality when certified nurse-midwives attended planned home births was almost three-fold higher, at 9.28 per 10,000. With non-certified midwives, mortality for babies born in planned home births was 12.44/10,000.

“It takes a village to safely deliver a baby,” Grunebaum said. “The home is not a safe place … complications can happen suddenly to every delivery.”

Grunebaum says the lack of attendants at a home birth make it harder to monitor labor adequately and care for a newborn at risk of complications like asphyxia, or lack of breathing. Women are also deprived of the option of an epidural or a cesarean delivery.

Emergencies also mean that nearly half of women who have planned home births end up having to transfer to a hospital, which further endangers their newborns, the authors note.

Dr. Aaron Caughey, associate dean for Women’s Health Research and Policy at Oregon Health & Science University in Portland, who wasn’t involved in the study, said its results are “very consistent with what we know.”

“The United States is not guided in a single way the way some other nations are,” Caughey said, adding that the strongest factor determining delivery location is the mother’s preference.

“However, economic factors can occasionally play a role,” he said.

The American College of Obstetricians and Gynecologists recommends hospitals and accredited birth centers as the safest settings for birth.

SOURCE: American Journal of Obstetrics & Gynecology, online February 7, 2020.