Parents-to-be warned to consider risks of home births

Couples should be warned of the risks of home births, including the “silent tragedy” of long-term disability for their babies, experts have said.

While studies have shown an increased risk of a baby dying during a home birth, little has been said about the chance of disability — which can occur due to factors such as oxygen starvation, they argued.

The authors said deprivation of oxygen — hypoxic ischemic encephalopathy (HIE) — can lead to cerebral palsy, and motor and cognitive problems that can be detected at school-age.

While campaigners in favour of home births focus on the fact women may need less intervention, such as forceps, there has been little focus on the risk of disability.

The authors said “part of the enthusiasm for home birth is related to cost-cutting”, adding: “Couples should be warned of avoidable and foreseeable risks of future child disability.”

Writing in the Journal of Medical Ethics, Professor Julian Savulescu, from the faculty of philosophy at Oxford University, and obstetrician and gynaecologist Associate Professor Lachlan de Crespigny, of the University of Melbourne, said when problems occur at home there can be a delay in transferring women to hospital for specialist help.

“Delay in transferring to a tertiary hospital may result in permanent severe disability that will persist for the rest of that person’s life,” they said. “Vital delays are inevitable in some cases. These can lead to disability, which was avoidable if the delivery had occurred in hospital.”

The authors argue that when labour is obstructed or the baby starts to suffer from lack of oxygen, the “immediate treatment” of the baby is crucial for its immediate and longer term health.

To take an extreme example, the lack of equipment to deal quickly when such events occur at home might result in avoidable quadriplegia, they added.

A 2011 Oxford University study found babies born to first-time mothers who choose a home birth are almost three times more likely to die or suffer a medical complication.

The Birthplace in England study found these babies were 2.8 times more likely to suffer serious problems compared with those born in hospital obstetric units.

Problems included stillbirth after the start of labour, the baby dying within the first week of birth, brain injury, fractures to the upper arm or shoulder during birth, and faeces in the lung.

There was no increased risk for babies whose birth was planned at units led by midwives, either ones that stand alone in the community or which are attached to a hospital.

There was also no increased risk for second or subsequent babies whose mothers planned a home birth, the study found. The overall risks were low.

The researchers pointed to a further study which found that while women experienced lower rates of Caesarean section during home births, the risk of the baby suffering seizures or having a low wellbeing score (known as Apgar score) at birth was higher.

They also pointed to an analysis of 12 studies of 500,000 planned home births in low-risk women that showed death rates among babies tripled.