Where it is best for the birth: the hospital or at home?

Where it is best for the birth: the hospital or at home? - In the second half of the 20th century, the birth of the hospital had become the norm in most Western countries. 

Hospital birth monitors and interventions, many of which saved the lives of mothers and babies. At the same time, births have become more and more - and some would say unnecessarily - medicalized.

Many might also argue that the pendulum has swung too far procedure. For example, from 1970 to 2010, the caesarean section rate US It doubled - but (if both are low) risk of a baby dying during delivery was unchanged, and the risk of dying mother little Rose. In an apparent effort to avoid unnecessary intervention, and find an alternative for the room environment, it is not surprising that some women have turned again to home birth.

Home birth safe?

We do not have better data to answer this question. The ideal way to respond would be a randomized controlled trial. But the random part (the place of delivery would essentially be decided by the draw) would be unacceptable to most women.

So instead, women and their doctors have had to rely on after analyzing the reality of large sets of administrative data (such as information recorded on birth certificates). 

There are some problems with this type of analysis.

There may be differences between women who give birth at home and those who delivered at the hospital are not counted in the time to draw conclusions. For example, a woman may choose to give birth at home because she does not have access to care, and can therefore be more likely to suffer complications. 

On the other hand, maybe the women who choose home birth focuses on a lifestyle designed to prevent problems and health interventions in general (healthy diet, not smoking, etc.). 

So when evaluating the results of the home birth, it is possible that the results are due to factors on the woman herself both as a place where you have your baby. 

One of the things that make mockery of these hard data is that until recently, there was no way to distinguish between planned home births and planned home deliveries. planned home births may include factors that make home birth are riskier than it may actually be (eg, birth due to unexpected emergencies or in women who have not had access to regular prenatal care ). 

On the other hand, counting the deliveries from the house, but can not be completed as "hospital births" could hide the risk of delivery at home complicated.Women and those who care about their health and have been an urgent need for better data and analysis.

A single set of data gives an idea

A recent article in the New England Journal of Medicine describes a study in which the Oregon researchers have managed to overcome some of these data problems. Oregon birth certificate register if an expected mother to give birth at home or in hospital.

The researchers also had access to information about the health of the mother (such as diabetes or high blood pressure), which puts them at higher risk for problems during labor and delivery. For the study, the researchers excluded planned home births and that included what appeared to be healthy singleton deliveries (no twins or more). 

In its analysis, the risk of dying of a baby was small in any context, but the group is providing 1.8 per 1,000 for planned hospital births compared to 3.9 per 1000 births for unplanned outside the hospital.

Provided outside the hospital at birth was also associated with lower Apgar scores and a greater likelihood that the baby has a crisis or need a respirator, and a mother who had need a blood transfusion. 

However, planning for home delivery has also been associated with lower rates of admission need a baby to an intensive care unit and a lower rate of obstetric interventions, including the use of drugs or other ways to start (induce) or strengthen (increase) labor or vaginal forceps or vacuum delivery, cesarean delivery, and severe lacerations of the vagina.

What this means for women and their doctors? 

These results are consistent with other studies of sense to me, since many obstetricians. Sometimes an emergency occurs and you have the tools, medicines and facilities to respond quickly can make a difference. But have all these things on how the hand can also be used in cases where doing nothing would have been just as well. 

It is important to recognize that although the risk of problems for the babies was "superior" in the home birth group are not "high" in both groups. The difference was considered in absolute terms of the order of 0.5 to 2 infant deaths per 1,000 births. 

This risk is similar to other options supported in obstetric care, as a trial of labor after a cesarean past. The group home birth had lower rates of caesarean section and other complications that can affect the health of the mother. 

The risks to be considered for each option are very different, but this data can help women make decisions based on what they value most.

 

Finally, about 15% of women planning home birth requires a transfer to the hospital. Note that currently, there are no national standards of the United States to integrate home birth in a continuum of care.  

There are no agreed criteria to help identify good candidates for home birth, and there are rules to ensure adequate training for assisted home births. We need these systems and criteria to the US You should consider matching the recent call in Britain to encourage and support home birth. 

By: Jeffrey Ecker, MD.