Babies delivered at home by midwives are four times more likely to suffer neonatal death than babies delivered in a hospital by midwives, according to a forthcoming study to be presented this week at the annual meeting of the Society for Maternal-Fetal Medicine. The difference appears to center around where the births actually take place — hospital or home — rather than who attended the birth.
Researchers analyzed data from 14 million births and determined that the absolute risk of neonatal mortality was 3.2 deaths out of every 10,000 births for hospital midwife births, compared to 12.6 out of 10,000 for home midwife births.
Statistically speaking, 12 deaths out of 10,000 is still extremely low—though this would be cold comfort if your baby were one of those twelve. In both cases, of course, the vast majority of babies turned out fine; the higher death rate for home deliveries presumably involves complications of the sort that are fairly simple to treat with the modern medical technologies hospitals have available, yet can be fatal without intervention.
The SMFM press release said this:
Given the study’s findings, Amos Grunebaum, M.D. and Frank Chervenak, M.D., the main authors of the study, said that obstetric practitioners have an ethical obligation to disclose the increased absolute and relative risks associated with planned home birth to expectant parents who express an interest in this delivery setting, and to recommend strongly against it.
The authors also continued to say that hospitals should create a welcoming and comfortable birthing environment, as well as address unnecessary obstetric interventions, both of which are often a primary motivation for planned homebirth.
Cost a factor
This is no doubt true, but there's another possible motivation behind the rise of interest in home births—the high, and pretty much impossible to predict, cost of an American hospital delivery. Two weeks ago, we told you about a different study analyzing the costs of giving birth:
Researchers at the University of California San Francisco (UCSF) conducted a wide-ranging study of hospitals in the state, finding that patients could be charged as little as $3,296 or as much as $37,227 for an uncomplicated vaginal delivery. It all depended on the hospital they chose.
For a C-section, the costs were much higher, ranging anywhere from $8,312 to nearly $71,000. And these were uncomplicated births – few of the women in the study had serious health issues and most were discharged within six days of admission.
Based on their findings, the researchers conclude that it is almost impossible for a woman to predict how much it will cost to have a baby.
For that matter, it can be impossible for anybody to predict how much any medical procedure will cost; the answer varies depending on whether or not you have insurance, which provider you have if you do, which hospital you visit, and other factors we can't even guess at because medical billing procedures are so opaque.
And, while we are strong advocates of such fiscal-responsibility techniques as “determining the total cost of an item or service before you decide to buy it,” this only works when the total cost is actually made available to you.
Perhaps expectant mothers would be more willing to give birth in hospitals if they weren't required to pay with a blank check liable to be filled out with an amount in the high five figures.