The increased
neonatal mortality risk is associated with the location of a planned birth, rather than the credentials of the person delivering the baby.
The reported
neonatal mortality risk for homebirths is 0.2 %, or 20 out of 10,000 home births.
For now, there is not conclusive data that proves home births are any more dangerous than hospital births and carry the 2 - 3 fold
neonatal mortality risk.
Not exact matches
Too many high -
risk mothers still give birth to endangered newborns who cost the nation billions of dollars for
neonatal intensive care and add to infant
mortality statistics.
Homebirth with American homebirth midwives has almost triple the
neonatal mortality rate for low
risk hospital birth in the US.
That's TEN TIMES HIGHER than the national
neonatal mortality rate for low
risk hospital birth with a CNM.
Looking behind the Curtain A recent study of elective induction at term purports to show that it would reduce perinatal
mortality without affecting spontaneous birth rates, although it would increase admission to a special
neonatal care unit if done before 41 weeks, which contradicts the current belief that elective delivery at 39 weeks poses no excess
risk.
Which raises the question: Is Dahlen deliberately trying to trick readers, since a
neonatal mortality rate of 2.2 / 1000 is 5X higher than comparable
risk hospital birth?
Home birth is associated with a
neonatal mortality rate 3 - 8 times that of comparable
risk hospital birth.
The study shows a VERY HIGH
neonatal mortality rate, 400 % higher than comparable
risk hospital birth.
I don't know the perinatal
mortality rate for low
risk births in Australia, but I do know that the
neonatal death rate is 0.4 / 1000.
However, homebirths should only be recommended to women who are classified as low -
risk, as this data demonstrates an increased
risk of
neonatal mortality among homebirths
The latest data from the CDC (available on the CDC) Wonder website shows that homebirth with a non-nurse midwife has a
neonatal mortality rate more than 7 times HIGHER than low
risk hospital birth.
Internationally it is one of the few, and the largest, prospective studies of home birth, allowing for relatively stable estimates of
risk from intrapartum and
neonatal mortality.
The intrapartum and
neonatal mortality was 1.7 deaths per 1000 low
risk intended home births after planned breeches and twins (not considered low
risk) were excluded.
Planned home births with certified professional midwives in the United States had similar rates of intrapartum and
neonatal mortality to those of low
risk hospital births
Most studies of homebirth in other countries have found no statistically significant differences in perinatal outcomes between home and hospital births for women at low
risk of complications.36, 37,39 However, a recent study in the United States showed poorer
neonatal outcomes for births occurring at home or in birth centres.40 A meta - analysis in the same year demonstrated higher perinatal
mortality associated with homebirth41 but has been strongly criticised on methodological grounds.5, 42 The Birthplace in England study, 43 the largest prospective cohort study on place of birth for women at low
risk of complications, analysed a composite outcome, which included stillbirth and early
neonatal death among other serious morbidity.
Combined intrapartum and
neonatal mortality in studies of planned out of hospital births or low
risk hospital births in North America (at least 500 births)
Third, while it found a dramatically increased
risk of
neonatal mortality, it found no difference in perinatal
mortality.
The Johnson and Daviss study actually shows that homebirth with a CPM has nearly triple the rate of
neonatal mortality of low
risk hospital birth.
I posted the Wisconsin
neonatal mortality statistics in a comment thread on a Newsweek article about midwifery which quoted Prown, asking why she did not mention that homebirth midwives in Wisconsin had triple the
neonatal death rate of low
risk hospital birth.
Similar relationships are seen between birthweight and
neonatal mortality, with the least
risk of
neonatal death occurring in children born weighing more than 3.5 kg.
It may also help explain why the US does comparatively well for perinatal outcomes but very badly in terms of infant
mortality, if massive, high tech, emergency, intervention, which is readily available, has kicked the can down the road, past the
neonatal period, but the baby dies at some later date (and it will be higher
risk for the rest of infancy, at least, due to prematurity).
GBS may be the most common infectious cause of
neonatal mortality but it is extremely rare in low
risk birth.
In fact, I've given the exact statistic... a 0.11 % increase in absolute
risk of
neonatal mortality for homebirth vs hospital birth.
I do think it is unethical to deride a woman for deciding that something else did in fact outweigh the 0.11 % increased
risk of
neonatal mortality from attempted homebirth.
In fact, the first statistic I ever came across was what you referred to... a 3-fold
risk of
neonatal mortality for homebirths.
«The planned category of out - of - hospital births is seen to be a generally low -
risk group for
neonatal mortality, with very few low - birth - weight births and fewer teenage, low - educational levels and unwed mothers than found statewide, «the researchers said.
As for
neonatal mortality rates... well everybody is certainly entitled to their own
risk / benefit analysis.
Personally, I think it's curious how many physicians and mothers - to - be place such a high emphasis on the 0.11 %
risk reduction of
neonatal mortality from hospital births, while thinking nothing of engaging other common practices (i.e. poor dietary habits, overuse of antibiotics, participation in contact sports) that certainly increase their child's lifetime
risk of chronic disease, injury, or even death.
Here are the
mortality rates (excluding lethal anomalies) for babies born to low
risk women that were confirmed to be alive at the start of labor but die either during birth (intrapartum) or in the first week of life (early
neonatal):
Nevertheless, «travel times greater than 20 minutes [to a healthcare facility] have been associated with increased
risk of adverse
neonatal outcomes, including
mortality.»
The definition of low
risk used in the cohort study was based on criteria contained in the NICE Intrapartum Care Guidelines.11 The primary clinical outcome was a composite measure of adverse perinatal outcomes encompassing perinatal
mortality and specified
neonatal morbidities (box).
These significantly increased
risks of
neonatal mortality in home births must be disclosed by all obstetric practitioners to all pregnant women who express an interest in such births.
The authors concluded that health facility delivery is found to reduce the
risk of
neonatal mortality by 29 % in low and middle income countries.
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The authors concluded that the findings of this study showed a significantly increased total and early
neonatal mortality for home births and even higher
risks for women of 41 weeks or longer and women having a first birth.
Before a vaginal breech delivery is planned, women should be informed that the
risk of perinatal or
neonatal mortality or short - term serious
neonatal morbidity may be higher than if a cesarean delivery is planned, and the patient's informed consent should be documented.
Evidence suggests that initiation of breastfeeding in the first day of life is associated with a significant reduction in the
risk of
neonatal mortality when compared with delaying breastfeeding for more than 24 hours after birth.
Infant and
neonatal mortality for primary cesarean and vaginal births to women with «no indicated
risk,» United States, 1998 - 2001 birth cohorts.
I think the closest I've seen was the Birthplace study done in the UK, which showed, for ultra low -
risk women in the UK who had a previous vaginal birth, homebirth could be almost as safe as hospital (first - time moms had higher incidences of perinatal
mortality and
neonatal brain injuries).
On the other hand, for a first time mother with no complications at the start of labor, the Birthplace Study found a nearly 3 x greater
risk of intrapartum /
neonatal loss, and the data from the Netherlands suggests that although the rates aren't high enough to affect the overall perinatal
mortality rate, there are greater
risks out of hospital if a complication does occur.
Even studies that claim to show that homebirth is as safe as hospital birth, like the Johnson and Daviss BMJ 2005 study, ACTUALLY show that homebirth with a CPM has triple the rate of
neonatal mortality of comparable
risk women who delivered in the hospital in the same year.
Perinatal
mortality,
neonatal mortality, or serious
neonatal morbidity was significantly lower for the planned caesarean section group than for the planned vaginal birth group (17 of 1039 [1.6 %] vs 52 of 1039 [5.0 %]; relative
risk 0.33 [95 % CI 0.19 - 0.56]; p < 0.0001).
Intrapartum and
neonatal mortality among low -
risk women in midwife - led versus obstetrician - led care in the Amsterdam region of the Netherlands: a propensity score matched study
Comparing intended home and hospital births in a cohort of 529688 low
risk pregnancies in primary care in the Netherlands, de Jonge et al recently found low rates of perinatal
mortality (intrapartum and
neonatal death before 7 days) and admission to the NICU.11 They concluded that an intended home birth does not increase
risks compared with an intended hospital birth in this population.
Giving pre-lacteal feeds, i.e. something other than mother's milk before beginning to breastfeed, also increased the
risk of
neonatal mortality.
CONCLUSIONS: Planned home birth for low
risk women in North America using certified professional midwives was associated with lower rates of medical intervention but similar intrapartum and
neonatal mortality to that of low
risk hospital births in the United States.
Planned home birth for low
risk women in North America using certified professional midwives was associated with lower rates of medical intervention but similar intrapartum and
neonatal mortality to that of low
risk hospital births in the United States.
The intrapartum and
neonatal mortality among women considered at low
risk at start of labour, excluding deaths concerning life threatening congenital anomalies, was 1.7 deaths per 1000 planned home births, similar to
risks in other studies of low
risk home and hospital births in North America.