Newborn and Maternal Outcomes in Out-of-Hospital Delivery: A Review

Abstract

Introduction: As maternity services became available out-of-hospital births diminished in favor of planned hospital deliveries. After an early decline, there is a recent increase of out-of-hospital births in United States, from 0.87% in 2004 to 1.36% in 2012. Reasons why women have an out-of-hospital birth differ between countries. Many women feel that hospital is the safest place to give birth, but others believe that hospital is impersonal and a place that provoke anxiety. Maternal outcomes due to labor include: Obstetric interventions’ and non-related with interventions. Newborn outcomes comprise: 5 min Apgar 90% for gestational age or ≥ 4000 g), postdatism (≥ 42 weeks’ gestation), assisted ventilation requirement and neonatal/perinatal death. The aim of this review was to understand the real impact of out-of-hospital births in newborn and maternal outcomes. Methods: The search was performed on PubMed, from which 45 articles met all inclusion criteria. Results: In developed countries, home birth rate is very low (1-2% in UK, 1% in New Zealand, 0.6% in USA, 0.5% in France and 0.4% in Australia), the exception is Netherland (30%). In developing countries, the situation is quite different: Home birth rate is 95% in Bangladesh, 41% in Mozambique and 90% in Nepal. Unplanned out-of-hospital births had higher incidence of maternal and newborn complications. Planned out-of-hospital deliveries also showed higher incidence of newborn complications, especially when transferred babies were considered also out-of-hospital births. Discussion: Although some studies showed that maternal-fetal outcomes occur in the same proportion in planned low risk out-of-hospital births compared to hospital births, unplanned or high-risk out-of-hospital births show higher incidence of maternal and newborn complications. Conclusion: The safety of out-of-hospital births remains controversial because the benefits may be overcome by the disadvantages, given the maternal and birth risk and the unplanned scenarios.