Research LetterMost Intended Home Births in the United States Are Not Low Risk: 2016−2018
Section snippets
Objective
Pregnant patients with high risk factors are at increased risk for morbidity and mortality.1,2 It has been claimed that intended home births in the United States are largely restricted to low-risk patients.3 The objective of this study was to assess whether this was indeed the case.
Study Design
We used the United States Department of Health and Human Services (US DHHS), Centers for Disease Control and Prevention (CDC), National Center for Health Statistics (NCHS), Division of Vital Statistics, Natality public-use data 2016−2018, on CDC WONDER Online Database, September 2019 (accessed at http://wonder.cdc.gov/natality-expanded-current.html on Oct. 22, 2019, 4:10:41 PM) to calculate risks known to increase maternal and/or neonatal morbidity and mortality for intended home births listed
Results
The Table shows pregnancy risk factors among intended home births. There were 4.2% births with prior cesarean deliveries, 23.4% were births to mothers who were ≥35 years old, 4.7% were ≥40 years old, 21.5% were ≥41 weeks’ gestation, 3.6% were ≥42 weeks’ gestation, 17.4% were nulliparous, 7.5% were grand multiparas, and 12.6% were obese.
Conclusion
Adverse outcomes are known to occur more commonly with certain risk factors.1, 2, 3, 4 Our study shows that well over 60% of all intended home births in the United States are not low risk, and that these women have at least a single or several combined obstetric risk factors.
Appropriate patient selection to include only low-risk women among intended home births would reduce adverse outcomes. This can be done best by establishing risk guidelines for patient selection at intended home births as
References (5)
- et al.
Critical appraisal of the proposed defenses for planned home birth
Am J Obstet Gynecol
(2019) - et al.
“Doing something” about the cesarean delivery rate
Am J Obstet Gynecol
(2018)
Cited by (0)
The authors report no conflict of interest.