Thursday, March 22, 2007

Revised NICE report still shows increased risk of neonatal death at homebirth

Last year, the National Institute for Health and Clinical Excellence released its guidelines for intrapartum care. NICE is an independent organisation responsible for providing national guidance on promoting good health and preventing and treating ill health. The original guidelines reported an increased risk of neonatal mortality at homebirth. I wrote about the guidelines at the time (National Institute for Clinical Excellence says homebirth has a higher rate of intrapartum death) and also about the fact that political pressure was brought to bear on NICE in an effort to get them to change their report since the British governement was recommending homebirth as a way to control healthcare costs (Political pressure exerted to change NICE resport). In addition, homebirth advocates strongly protested the results. Therefore, NICE solicited input from all relevant childbirth organizations and from individuals. NICE released the revised report today.

According to the NICE report:
Home birth:
* Women who have planned birth at home have more spontaneous vaginal birth, a reduced likelihood of caesarean section, and more likelihood of intact perineum, compared with those who planned birth in an obstetric unit.
* The uncertain evidence suggests intrapartum-related perinatal mortality (IPPM) for booked home births, regardless of their eventual place of birth, is the same as, or higher than for birth booked in obstetric units.
* If IPPM is higher, this is likely to be in the group of women in whom intrapartum complications develop and who require transfer into the obstetric unit.
• Local transfer rates should be given for both women having their first and subsequent babies. Evidence shows between 4% and 20% of women in labour (nulliparous 30–55%; parous 1–15%) will transfer to the obstetric unit.
* When unanticipated obstetric complications arise, either in the mother or baby, during labour at home, the outcome of serious complications is likely to be less favourable than when the same complications arise in an obstetric unit.
* If birth is planned and takes place at home the IPPM is likely to be the same as in a low risk group of women giving birth in an obstetric unit.
Today's Guardian reports the story here: Health watchdog gives warning on higher risks of home births.

It is worth reading the entire NICE chapter because it contains an excellent summary of the existing research evidence. As the chapter repeatedly emphasizes, most homebirth studies are poorly done and invalid. In summary, this revised NICE report confirms the fact that homebirth has an increased risk of neonatal mortality compared to hospital birth.


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