jeudi 28 juillet 2016

ACOG: Educate Patients on Planned Home Births

Planned home births in the United States have greater risk of perinatal death and complications, but a reduced risk of maternal interventions, said the American College of Obstetricians and Gynecologists in an updated committee opinion.

There is more than a two-fold increased risk in perinatal death (1-2 per 1,000 births) and a more than three-fold increased risk of neonatal seizures of neurologic dysfunction (0.4-0.6 per 1,000) associated with home birth. Despite these risks, the procedure is the safest when supervised by a physician, certified nurse midwife, certified midwife, or a midwife who meets the International Confederation of Midwives' Global Standards for Midwifery Education.

"Although [ACOG] believes that hospitals and accredited birth centers are the safest settings for birth, each woman has the right to make a medically informed decision about delivery," wrote the Committee on Obstetric Practice. The opinion was published on ACOG's Web site and will appear in the August issue of Obstetrics and Gynecology.

At the same time, however, the opinion acknowledged that much of the evidence on home birth safety and outcomes derives from other countries.

Co-author Joseph Wax, MD, of ACOG, told MedPage Today that the committee had been hesitant to generalize these findings to the U.S. because of the differences in healthcare systems between nations.

"We want clinicians to have more informed conversations with women who are thinking about out-of-hospital birth and also to be able to provide current and accurate information with regard to home birth in the United States," he said. "We have some additional recent data that provides some new information, which may be very helpful for informing conversations with women who may be considering home births."

A study of Oregon births published late last year in the New England Journal of Medicine found a small but significant increase in the risk and rates of perinatal death with planned home births compared with hospital births. There were also lower rates of maternal interventions, such as labor augmentation and induction or cesarean delivery, as well as lower rates of severe perineal lacerations.

Additional recent studies suggested that, among low-risk women, the risk of intrapartum and neonatal deaths are more common with home versus hospital births, and that home births are associated with an increased risk of low Apgar scores, neonatal seizures, as well as neonatal death.

Additionally, the authors maintain that fetal malpresentation, multiple gestation or prior cesarean delivery to be "an absolute contraindication" to planned home birth, citing evidence that such factors are associated with a higher risk of perinatal death.

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ACOG: Educate Patients on Planned Home Births

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