Home versus hospital birth--process and outcome.
A constant small, but clinically important, number of American women choose to deliver at home. Contradictory professional and public policies reflect the polarization and politicization of the controversy surrounding this birth option. Women opting for home birth seek and often attain their goals of a nonmedicalized experience in comfortable, familiar surroundings wherein they maintain situational control. However, home deliveries in developed Western nations are often associated with excess perinatal and neonatal mortality, particularly among nonanomalous term infants. On the other hand, current home birth practices are, especially when birth attendants are highly trained and fully integrated into comprehensive health care delivery systems, associated with fewer cesareans, operative vaginal deliveries, episiotomies, infections, and third and fourth degree lacerations. Newborn benefits include less meconium staining, assisted ventilation, low birth weight, prematurity, and intensive care admissions. Existing data suggest areas of future research regarding the safety of home birth in the United States.


BACKGROUND
Obstetricians & Gynecologists, Family Physicians.


OBJECTIVE
After completion of this educational activity, the participant should be better able to assess perinatal outcomes described in the reported literature associated with home births in developed countries, list potential advantages and disadvantages of planned home births, and identify confounders in current literature that impact our thorough knowledge of home birth outcomes.
Wax
Joseph R
JR
College of Medicine, University of Vermont, Burlington, VT, USA. waxj@mmc.org
Pinette
Michael G
MG
Cartin
Angelina
A
D001720:Birth Injuries / Q000453:epidemiology; D036861:Delivery, Obstetric; D005260:Female; D006700:Home Childbirth / Q000706:statistics & numerical data*; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D007231:Infant, Newborn; D008471:Meconium Aspiration Syndrome / Q000453:epidemiology; D017063:Outcome Assessment, Health Care; D010102:Oxygen Inhalation Therapy / Q000706:statistics & numerical data; D054238:Perinatal Mortality; D010502:Perineum / Q000293:injuries; D011247:Pregnancy; D011256:Pregnancy Outcome