Planned home births: the need for additional contraindications

Area of Science:

• Obstetrics and Gynecology
• Neonatal Health
• Public Health

Background:

• Planned home births are associated with fewer medical interventions but higher risks of adverse neonatal outcomes, including death.
• The American College of Obstetricians and Gynecologists recommends strict criteria for selecting candidates for planned home births.

Purpose of the Study:

• To identify additional risk factors beyond the established three that may contraindicate planned home births.
• To evaluate the neonatal mortality rates associated with specific risk factors in planned home births.

Main Methods:

• A population-based, retrospective cohort study analyzed term, normal weight, singleton births from 2009-2013.
• Neonatal deaths were compared across hospital births (by midwives or physicians) and planned home births.
• Risk factors examined included breech presentation, previous cesarean delivery, parity, maternal age, and gestational age.

Main Results:

• Planned home births had a significantly higher overall risk of neonatal death compared to hospital births.
• Specific risk factors significantly increasing neonatal death risk in planned home births included breech presentation, nulliparity, previous cesarean delivery, and gestational age ≥41 weeks.
• Planned home births with any of the five risk factors showed higher neonatal death risks, further elevated when combined with advanced maternal age.

Conclusions:

• Two additional risk factors—first-time births and gestational age ≥41 weeks—are associated with significantly increased neonatal mortality at planned home births.
• These factors, alongside previous cesarean delivery, malpresentation, and multiple gestations, should be considered absolute contraindications for planned home births.
• Expanding the list of contraindications can help reduce perinatal death and improve outcomes for planned home births.