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Apgar Score of 0 and Seizure/Serious Neurologic Dysfunction in Home Births of Patients With Prior Cesarean Delivery [2]

Grunebaum, Amos, MD; Chervenak, Frank A., MD

Obstetrics & Gynecology: May 2016 - Volume 127 - Issue - p 1S
doi: 10.1097/01.AOG.0000483619.33365.2e
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INTRODUCTION: There has been an increase of vaginal births after cesarean (VBAC) among planned home births. The objective of this study was to evaluate the risks of Apgar score of zero and seizure or serious neurologic dysfunction for newborns of patients delivering at home with a VBAC.

METHODS: Retrospective cohort analysis of the 2007–2013 CDC birth certificate data for infants at term (37 weeks and over) with a birthweights over 2,499 grams, and mothers with a prior cesarean delivery (pCD). We compared planned home births by midwives with hospital births.

RESULTS: From 2007–2013 there were 2,404,505 hospital births and 4,544 planned midwife assisted home births of women with pCD in this study population. The incidence of Apgar 0 was 0.093/1,000 among hospital births and 0.660/1,000 among home births (RR 7.09; 95% CI 2.27–22.13 P<.001). The incidence of seizure or serious neurologic dysfunction was 0.192/1,000 for hospital births and 1.98/1,000 for home births (RR 10.15; 95% CI 5.25–19.63 P<.0001).

CONCLUSION/IMPLICATIONS: When compared to those delivered in the hospital, homebirths in women with pCD are associated with significantly elevated preventable neonatal risks: Apgar zero (RR 7.09) and seizure or serious neurologic dysfunction (RR 10.15). This increased risk is likely due to the inability of fetal monitoring and doing a timely CD outside a hospital. This information should be shared with all patients with a pCD who are interested in attempting a home birth. Professionals should strongly recommend against planned homebirths in women with pCD.

Weill Medical College of Cornell University, New York, NY

Financial Disclosure: The authors did not report any potential conflicts of interest.

© 2016 by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.