This is to date the largest comparative study in terms of sample, performed on deliveries in hospitals and at home. It concluded that a significantly higher risk for the child if born at home. The opposite results to those obtained in previous and many, data compilations. The main author of this work brings some clarifications.
The study was conducted by doctors and researchers at New York-Presbyterian / Weill Cornell Medical Center. It must be published in October in the American Journal of Gynecology and Obstetrics. It will stimulate debate (this is already the case on Parents.fr where a brief news provoked virulent comments) because its conclusions contradict the results obtained by previous research. His subject? Home deliveries (AAD), planned and not impromptu. Its characteristic? It would be the largest study of its kind conducted to date. His cohort is indeed impressive: more than 13 million of birth occurred in the US between 2007 and 2010. Of these, 67,429 were held at home. The researchers conclude that these planned home births would be ten times more at risk in terms of infant mortality, the hospital births. This risk is 14 times higher for the first child. They also suggest an increased risk of neurological disorders.
Dealing with unexpected complications
The authors stress: for them, it is the place that explains this differential and not the qualifications of this professional. "Giving birth at home is more dangerous, that the birth takes place in the presence of a doctor or a midwife, says Dr Amos Grunebaum, lead author of the study. Unexpected complications can occur which only a structure equipped with trained personnel used to working in a team can face. "A previous study, a meta analysis this time, published in 2010, again in the American Journal of Gynecology and Obstetrics, concluded a mortality risk multiplied by 3. She had been heavily criticized by the scientific community because of several methodological bias.
The midwives training and prevention at the heart of the debate
Most studies (well compiled on the Collective Site interassociative around the Birth) conducted on the subject does not show a convincing difference between home births and hospital births. Some are even tip the balance in favor of the ADA, as this Dutch study published by the British Medical Journal in June 2013 and showed a lower rate of postpartum haemorrhage and maternal death during home deliveries. For Dr. Grunebaum the cohorts studied are not sufficiently important and it would be the specificity of its study to count a large number of cases. As the number of cases observed, the greater the statistical risk makes sense. The Netherlands is nonetheless an interesting example because 20-25% of births take place at home and that studies therefore focus on sufficiently substantial cohorts, without putting to much evidence of specific problems with home births (see the survey published in Obstetrics and Gynecology, vol 118, November 2011). The downside, however, the Netherlands must confront a very average perinatal rate (last PERISTAT investigation) that can be explained only partially by higher maternal age. According to Dr. Grunebaum, it is clear that "the formation of Dutch midwives, their ability to select upstream low-risk women, the successful integration of their work in the hospital and the small size of the country, contributing with much better results. " In the US the liberal midwives are less trained and poorly integrated care networks.
Strongly opposed to home births because of the results obtained at the end of her research, the doctor said, however favorable to birthing, provided they are hospital, ie adjacent motherhood. "Everything that is found away from a hospital play with the baby's life just to please the mother. But this mother would be the first affected if her baby was due. "This system is experienced in France, but almost at the sly. The bill officially launching the experimentation of these hospital birth centers was passed by the Senate in June and soon to be considered by the National Assembly.
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