A study in the American Journal of Obstetrics and Gynecology finds that when compared with hospital births, home births and birth center births showed longer labors and the infants had lower APGAR scores at 5 min. They also found that "out-of-hospital births are associated with otherwise less frequent maternal and newborn morbidity."
Maternal and newborn morbidity by birth facility among selected United States 2006 low-risk births
from the February 2010 issue of AJOG
We sought to evaluate perinatal morbidity by delivery location (hospital, freestanding birth center, and home).
Selected 2006 US birth certificate data were accessed online from the Centers for Disease Control and Prevention. Low-risk maternal and newborn outcomes were tabulated and compared by birth facility.
A total of 745,690 deliveries were included, of which 733,143 (97.0%) occurred in hospital, 4661 (0.6%) at birth centers, and 7427 (0.9%) at home. Compared with hospital deliveries, home and birthing center deliveries were associated with more frequent prolonged and precipitous labors. Home births experienced more frequent 5-minute Apgar scores <7. In contrast, home and birthing center deliveries were associated with less frequent chorioamnionitis, fetal intolerance of labor, meconium staining, assisted ventilation, neonatal intensive care unit admission, and birthweight <2500 g.
Home births are associated with a number of less frequent adverse perinatal outcomes at the expense of more frequent abnormal labors and low 5-minute Apgar scores.
Notice how they call a long labor "abnormal." Its only long and abnormal because obstetricians rarely see a truly natural birth.
So what does this study showing us? Are long labors and low 5 min APGAR scores an awful thing?
This means that home birth women were able to labor as long as was necessary to have their baby, instead of being told at the hospital that they were taking too long and therefore received medical interventions to speed things up.
This means that at home births the baby's cords weren't immediately clamped, as is usual hospital policy, which means that the baby was getting oxygen from the placenta for a little bit longer and therefore was still a little bit blue. They also weren't being slapped or rubbed to be made to cry, they were simply left to be calm as long as they were noticeably alert.
APGAR scores:Five factors are used to evaluate the baby's condition at one min and again at 5 min after birth. Each factor is scored on a scale of 0 to 2. Baby is rated on:
- Activity and muscle tone
- Pulse (heart rate)
- Grimace response/reflex irritability
- Appearance (skin coloration)
- Respiration (breathing rate and effort)
An extremely prolonged labor and very bad scores on the above 5 APGAR factors CAN indeed be worrying, but the study is showing that the results of these particular births, all low-risk women, resulted in fewer adverse outcomes. Therefore, there is no huge worry associated with out-of-hospital births for low-risk women.