WASHINGTON -- Women with a prior cesarean section who opted for a home birth for their next delivery had a greatly increased risk of infants with serious medical conditions, including seizures or neurological dysfunction, researchers said here.
In a large retrospective analysis of CDC birth certificate data, planned home births, even those attended by midwives, following a prior C-section were associated with a more than ten-fold increased risk of an infant having a seizure or serious neurologic dysfunction, such as hypoxic-ischemic encephalopathy (RR 10.53, 95% CI 5.3-19.6, P<0.001) compared with infants born in the hospital, reported , and , both of Weill Cornell Medical Center in New York City.
Action Points
- Note that this study was published as an abstract and presented at a conference. These data and conclusions should be considered to be preliminary until published in a peer-reviewed journal.
Home births attended by midwives following C-section were also linked to infants with an Apgar score of 0 for 5 minutes, indicating a nonresponsive, nonbreathing infant with no heartbeat versus hospital births (RR 7.07, 95% CI 2.3-22.1, P<0.001), they said in a presentation at the American College of Obstetricians and Gynecologists (ACOG) annual meeting.
In an interview with ѻý, Grunebaum said he had the dramatic increase in women opting for a vaginal home birth after C-section in recent years, and presented this data at the 2016 (SMFM) annual meeting. He noted that while ob-gyn guidelines from Australia and Europe direct midwives to exclude women with prior C-sections from having a home birth, no such guidelines exist in the U.S.
"American midwives have refused for many years to establish any guidelines for which women may be at higher risk [for planned home birth] and which are not," he said. "As a consequence, women with twins, with breach and with prior cesarean section continue to be delivered by midwives in planned home births in the U.S."
The presence of midwives actually attenuated the risk of complications, which were even higher for all planned home births compared with hospital births (RR 12.82, for low Apgar score and RR 11.23, for seizure/neurologic dysfunction, respectively, P<0.001 for both).
Grunebaum and Chervenak analyzed CDC birth certificate data from 2007-2013 and found 4,544 planned midwife-assisted home births compared with 2,404,505 hospital births. Actual incidence of complications was low with midwife-assisted home births -- 6.6 per 10,000 live birth for an Apgar score of 0 for more than 5 minutes and 19.8 per 10,000 live births for seizures/neurologic dysfunction.
However, the incidence of these complications in a hospital setting for women with a prior C-section was 0.93 per 10,000 and 1.92 per 10,000, respectively.
Grunebaum noted that even though the in this study, women with prior C-section risk other life-threatening complications, such as a ruptured uterus. This can threaten the lives of both the mother and the infant, but hospitals can be ready to do a quick C-section section, which is not possible in a home birth.
Asked about the practical implications of his study, Grunebaum said that he'd like to see ob-gyns discourage women to have a home birth after a C-section. He pointed out that clinicians warn women against smoking or drinking alcohol during pregnancy, so warning them about home birth C-section would not be any different.
Disclosures
Grunebaum and Chervenak disclosed no relevant relationships with industry.
Primary Source
American College of Obstetricians and Gynecologists
Grunebaum A, et al "Apgar score of 0 and seizure/serious neurological dysfunction in home births of patients with prior cesarean delivery" ACOG 2016; Abstract 2.