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Out of hospital birth

from Section 3 - Classic and rare scenarios in the neonatal period

Published online by Cambridge University Press:  05 March 2012

Tilman Humpl
Affiliation:
Hospital for Sick Children, Toronto
Georg Hansmann
Affiliation:
Children's Hospital Boston, Harvard Medical School
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Summary

The term “out of hospital birth” was coined in the twentieth century. Before 1900 it was the exception rather than the rule to give birth at a hospital. At this time fewer than 5% of all births took place at a hospital, increasing to almost 50% in 1940, and 99% in the 1970s. Several studies have demonstrated that planned home birth attended by appropriately qualified caregivers is safe. However, for this to be true, there should be no significant difference in morbidity and mortality when compared to standard hospital delivery. A healthy woman without contraindications (see below) has a low risk, both for herself and for the newborn infant. Midwives and/or obstetricians should discuss the advantages and possible risks of home birth with the expecting parents.

Outcome: the perinatal mortality of “intended home birth” in the USA, Canada, UK and Australia (studies from 1969 to 1996) ranges between 0.9/1000 and 5.1/1000.

Important factors influencing the mortality rate of the newborn

  • Underestimation of the risks associated with post-term birth

  • Twin pregnancy

  • Breech presentation

  • Lack of response to fetal distress

! It is important to differentiate a “planned home birth” (with the presence of a skilled attendant, e.g., midwife) from an “unplanned home birth,” which can rapidly turn into an emergency situation.

Type
Chapter
Information
Neonatal Emergencies , pp. 249 - 259
Publisher: Cambridge University Press
Print publication year: 2009

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