Infant mortality double in low-risk home births. (Washington State Study).

LOS ANGELES - Planned home births resulted in a twofold increased risk of both neonatal death and Apgar scores of 3 or less in a Washington state study using information from birth certificates and infant death certificates between 1989 and 1996, Dr. Jenny WY Pang said at the annual meeting of the American College of Obstetricians and Gynecologists.

Deaths due to congenital heart disease or respiratory distress were higher in infants whose births were planned at home, said Dr. Pang, who directed the study at the University of Washington, Seattle, and Children's Hospital and Regional Medical Center. Prolonged labor and postpartum bleeding were also significantly more common in planned home births.

Dr. Pang said that she and her associates took care to identify only low-risk pregnancies and deliveries that were intended to occur at home, rather than those that occurred at home due to an emergency.

Births to women with pregnancy-related complications were excluded from the analysis, as were multiple-gestation births and babies born at less than 34 weeks' gestation. All of the births were attended by a health professional.

Among 6,133 intended home births, 279 involved transfers to a hospital. Outcomes from both groups were compared with 10,593 planned hospital births that occurred in the same time period in the state.

The study identified 20 neonatal deaths in the home birth cohort (3.26 per 1,000), compared with 18 in the hospital birth cohort (1.7 per 1,000).

When only births at 37 weeks' gestation or greater were considered, the adjusted relative risks for problems associated with planned home births were: 2.24 for very low Apgar scores, 2.09 for neonatal mortality, 1.55 for ventilation greater than 30 minutes, 1.52 for postpartum bleeding, and 1.46 for prolonged ...