Neonatal Hypoxic Ischemic Encephalopathy and Planned Home Birth

Abstract

Introduction As planned home births increase, emerging evidence on the perinatal outcomes of newborns who were planned hospital births versus planned home births has been inconsistent, and a growing number of states have attempted to legislate community births. We sought to determine whether an association exists between neonatal hypoxic ischemic encephalopathy (HIE), a complication of ischemic birth injury, and planned location of birth. Methods A case‐control study design was used to compare data from neonates with HIE obtained from electronic health records at Kapiolani Medical Center for Women and Children in Honolulu, Hawaii, with data from neonates without HIE obtained from Hawaii state birth certificate data. A penalized backward stepwise logistic regression was performed to control for confounders. Results We included 164 neonates with HIE and 656 neonates in the control group. The odds of having been a planned home birth were 2.77 times higher in neonates with HIE compared with those without HIE (95% CI, 1.05‐6.87). After adjusting for insurance, mode of birth, meconium fluid, maternal hypertension, and chorioamnionitis, neonates with HIE were still more likely to have been a planned home birth compared with those without HIE (odds ratio, 11.56; 95% CI, 1.37‐118.77). Discussion Neonates with HIE were more likely to have been a planned home birth compared with neonates without HIE.

Alternate Birth Strategies

“…This difference in HIE rates was even more pronounced after adjusting for risk factors (OR 11.56 95% CI 1.37–118.77). 17 In a retrospective cohort study of planned out-of-hospital births in Oregon, there was increased risk of perinatal mortality after adjusting for maternal characteristics and medical conditions (OR 2.43, 95% CI 1.37–4.3). 18 There was also an increased risk of neonatal seizures in this study.…”

Adaptation and validation of the Portuguese version of the provider attitudes towards planned home birth (PAPHB) Scale

“…In addition, the guidelines promoted birth at home or in a birth centre for low-risk multiparous women as rates of intervention were particularly low in this cohort of childbearing women ( NICE, 2014 ). However, despite the evidence on the safety of home birth for women deemed at low risk for complications ( Murphy et al, 2022 ;Hollowell et al, 2017 ;Scarf et al, 2018 ;Thies-Lagergren et al, 2021 ;Davies-Tuck et al, 2018 ;Reitsma et al, 2020 ;Clancy and Gürgens, 2019 ;Galera-Barbero and Aguilera-Manrique, 2021 ) attitudes and opinions of maternity health care in many countries remain polarised ( Barreda et al, 2017 ;Alcaraz-Vidal et al, 2021 ;Buchanan et al, 2022 ).…”