We now resume a study that would reopen the debate on the safety of home birth, since in the September issue of “Evidence in Pediatrics” this meta-analysis is reviewed that showed that planned birth at home is related to a threefold increase in newborn deaths.
We know that this meta-analysis, entitled “Consequences for mothers and newborns in planned home births versus hospital deliveries: a meta-analysis” (“Maternal and newborn outcomes in planned home birth vs planned hospital births: a metaanalysis”), collects 12 published articles since 1945 in developed, English-speaking countries.
They accumulated two cohorts that are compared: one of 342,056 deliveries performed at home and another of 207,551 in the hospital setting.
What was intended to know is whether or not there are differences in interventionism, morbidity and maternal, perinatal and neonatal mortality. The main conclusion was that there is an increase in neonatal (triple) mortality in home births in front of the cohort who were born in the hospital.
Recall that neonatal mortality is the indicator used to express the risk of death or life expectancy of newborns during the first 28 days of life.
Perhaps the fundamental thing is that these conclusions force the immediate introduction of substantial improvements in the current model of home delivery assistance, wherever it is being promoted, for all women who wish to give birth at home.
Why giving birth at home also has its advantages: after reviewing the studies, it is concluded that planned delivery at home is associated with fewer interventions (episiotomy, epidural ...) and morbidity in the mother (infections ...).
Now, in all deliveries planned at home there is this increase in risk? It seems not. When the authors eliminate the articles where the qualification of the sanitary personnel was doubtful, the neonatal mortality is equated between both groups.
In spite of everything, the authors of the article in “Evidence in Pediatrics” consider that hospital delivery is more advisable:
In view of these results, as analyzed in this same number of Evidence in Pediatrics, there does not seem to be enough safety data and sufficient bibliographic weight to support, in our field, and at this time, home birth.
But, I think that quite reasonably, the authors continue stating that it is not possible, given the existing variability and the limitations of the available evidence, to dogmatize the suitability of one model or another. But that it is also not fair to upset what the health system has achieved for decades, which is to reduce the death of mothers and children.
I also believe that both types of childbirth should be improved, seeking respect for the woman's wishes, both at home and in the hospital, and safety. Yes home birth triples the cases of death of the baby compared to those born in the hospital, we must investigate the causes and not allow insecure home deliveries.
