Home birth: negative implications derived from a hospital-based birthing suite

Our study of 390 patients enrolled in a birthing suite program revealed that antepartum or intrapartum problems allowed only 160 (41%) to actually give birth in the birthing suite. Antepartum complications included premature labor in ten (2.5%), premature ruptured membranes in 31 (8%), postdatism in 50 (13%), preeclampsia in 27 (7%), and diabetes mellitus in five (1.3%). Intrapartum complications included meconium in 62 (16%), arrest of labor in 64 (16%), oxytocin use in 85 (22%), and fetal heart rate decelerations in 28 (7%). Two hundred ninety-seven births (76%) were spontaneous. Forty-two low-forceps deliveries (10%), 12 mid-forceps deliveries (3%), and 39 cesarean sections (10%) were done in the traditional labor and delivery suite. Puerperal complications included one uterine inversion, two cases of placenta accreta, one rectovaginal fistula, and two requirements of blood transfusion. Neonatal morbidity included 22 low Apgar scores (7%), two shoulder dystocia, three cytomegalovirus infestations, and one lethal anomaly. Six infants had meconium aspiration, two with severe hypoxia. Any of these complications would overwhelm the patient in home birth. Intense prenatal screening may decrease some risk factors, but the intrapartum period was found to pose unacceptable risks for home birth in this population.