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Home Versus Hospital Birth—Process and Outcome

Wax, Joseph R. MD†‡§; Pinette, Michael G. MD†‡§; Cartin, Angelina§

Obstetrical & Gynecological Survey: February 2010 - Volume 65 - Issue 2 - p 132-140
doi: 10.1097/OGX.0b013e3181d0fe5d

A constant small, but clinically important, number of American women choose to deliver at home. Contradictory professional and public policies reflect the polarization and politicization of the controversy surrounding this birth option. Women opting for home birth seek and often attain their goals of a nonmedicalized experience in comfortable, familiar surroundings wherein they maintain situational control. However, home deliveries in developed Western nations are often associated with excess perinatal and neonatal mortality, particularly among nonanomalous term infants. On the other hand, current home birth practices are, especially when birth attendants are highly trained and fully integrated into comprehensive health care delivery systems, associated with fewer cesareans, operative vaginal deliveries, episiotomies, infections, and third and fourth degree lacerations. Newborn benefits include less meconium staining, assisted ventilation, low birth weight, prematurity, and intensive care admissions. Existing data suggest areas of future research regarding the safety of home birth in the United States.

Target Audience: Obstetricians & Gynecologists, Family Physicians

Learning Objectives: After completion of this educational activity, the participant should be better able to assess perinatal outcomes described in the reported literature associated with home births in developed countries, list potential advantages and disadvantages of planned home births, and identify confounders in current literature that impact our thorough knowledge of home birth outcomes.

†College of Medicine, University of Vermont, Burlington, VT; ‡Dartmouth Medical School, Hanover, NH; and §Attending Perinatologist, Director, Research Assistant, Division of Maternal-Fetal Medicine, Maine Medical Center, Portland, ME

Chief Editor’s Note: This article is part of a series of continuing education activities in this Journal through which a total of 36 AMA/PRA category 1 credits™ can be earned in 2006. Instructions for how CME credits can be earned appear on the last page of the Table of Contents.

Unless otherwise noted below, each faculty’s spouse/life partner (if any) has nothing to disclose.

The authors have disclosed that they have no financial relationships with or interests in any commercial companies pertaining to this educational activity.

The Faculty and Staff in a position to control the content of this CME activity have disclosed that they have no financial relationships with, or financial interests in, any commercial companies pertaining to this educational activity.

Reprint requests to: Joseph R. Wax, MD, Maine Medical Partners Women’s Health, 887 Congress St, Suite 200, Portland, ME 04102. E-mail:

© 2010 Lippincott Williams & Wilkins, Inc.