Planned home birth risks: Informed consent implications?

Published in the New England Journal of Medicine on 31 December 2015 (so perhaps with limited scope for Australian comment as yet) was an article by Snowden & others entitled Planned out of hospital birth and birth outcomes.

The article may have implications for informed consent discussions.

Based on a study of almost 80,000 births in Oregon USA in 2012 – 2013, the authors suggest that a key shortcoming of prior studies of planned home birth is the classification of births by the eventual rather than the intended place of birth (i.e., intrapartum home-to-hospital transfers were counted as hospital births).

The authors concluded that after hospital transfers were reclassified as belonging to the planned out-of-hospital birth category, the rate of fetal death was higher among out-of-hospital births than among in-hospital births (2.4 vs. 1.2 deaths per 1000 deliveries).

Similarly, rates of perinatal and neonatal death were higher in the case of planned out-of-hospital births than in the case of planned in-hospital births after reclassification (perinatal death, 3.9 vs. 1.8 deaths per 1000 deliveries).