Tuesday, July 01, 2008

New Swedish study shows homebirth increases the risk of neonatal death

A recent study in Acta Obstetricia et Gynecologica Scandinavica, Outcome of planned home births compared to hospital births in Sweden between 1992 and 2004, shows (once again) that homebirth increases the risk of neonatal death.
...A total of 897 planned home births were compared with a randomly selected group of 11,341 planned hospital births... Results. During this period in Sweden the neonatal mortality rate was 2.2 per thousand in the home birth group and 0.7 in the hospital group ...
The authors point out that although the neonatal death rate in the homebirth group is almost triple that of the hospital group, the results do not reach statistical significance. However, they almost certainly would have if the authors had not included moderate and high risk women in the hospital group.
A randomly selected control group containing 11,341 (1:10) hospital births was obtained from the Medical Birth Register. Criteria for inclusion in the control group were a spontaneous, full-term, singleton birth (gestational week 37 to 42) during the study period.
In other words, the hospital group included all pregnancy complications besides prematurity.

In addition to showing that homebirth in Sweden has a higher neonatal death rate than hospital birth, the paper is notable for new information about waterbirth. Apparently one homebirth death was the result of freshwater drowning after birth in water.
A total of nine children (two in the planned home birth group and seven in the planned hospital group) in this study died intrapartum or before 28 days of age. In two cases the death occurred after labor in the birthing pool. The home birth case with death after birthing-pool labor has been subject to legal proceedings with three experts reviewing the case. Their conclusion is that the water birth, was the main reason for the death of the baby. Swedish national guidelines discouraging water births were consequently outlined.
The paper suffers from the limitation that the homebirth group is small, but the results are consistent with other homebirth studies: homebirth increases the risk of neonatal death. Moreover, yet another case of freshwater drowning at waterbirth has been reported.

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