AAP issues guidelines for home births

AAP issues guidelines for home births
AAP issues guidelines for home births

HealthDay News -- At least two caregivers should be present during home childbirth, including one who is formally trained to conduct full infant resuscitation and newborn evaluation, according to a new policy statement from the American Academy of Pediatrics (AAP).

"Regardless of the circumstances of his or her birth, including location, every newborn infant deserves health care that adheres to the standards highlighted in this statement," Kristi L. Watterberg, MD, and colleagues from the AAP Committee on Fetus and Newborn wrote in the statement, published online in Pediatrics.

Fewer than 1% of U.S. births are home births, according to background information in the recommendations, but the number of home births has been increasing among non-Hispanic white women. 

At the same time, current obstacles to home births are "pervasive and systemic," according to the AAP. The organization cited "wide variations in state laws and regulations, a lack of appropriately trained and willing providers and a lack of supporting systems to ensure the availability of specialty consultation and timely transport to a hospital."

These factors contribute to the two- to three-fold increase in neonatal mortality observed among home births compared with hospital births. To address theses gaps in care, the new guidelines summarize requirements for assessment, resuscitation and care of newborn infants born at home in efforts to help pediatricians provide support for women who choose this option.

The best candidates for home birth should possess the following criteria:

  • Absence of preexisting maternal disease or significant disease during the pregnancy
  • Singleton fetus born 37 to less than 41 weeks of pregnancy
  • Cephalic presentation
  • Labor that is spontaneous or induced as an outpatient
  • A mother who has not been referred from another hospital
The document also outlines several logistical systems necessary for planned home births. These include the presence of a certified nurse midwife, certified midwife, or physician, and a second appropriately trained individual to focus on the newborn; ready access to consultation; and a preexisting arrangement for safe and timely transport to a nearby hospital in case of emergency.

Care of the newborn should adhere to standards of practice and should include transitional care in the first four to eight hours after birth; monitoring for group B streptococcal disease; glucose screening; eye prophylaxis; vitamin K administration; hepatitis B vaccination; assessment of breastfeeding; and hyperbilirubinemia, universal newborn, and hearing screenings. In addition, follow-up screening care should be provided within 24 to 48 hours of birth.

"The AAP concurs with the recent position statement of the American College of Obstetricians and Gynecologists, affirming that hospitals and birthing centers are the safest settings for birth in the United States, while respecting the right of women to make a medically informed decision about delivery," the authors concluded.


References

  1. American Academy of Pediatrics. "Planned home birth." Pediatrics 2013; doi:10.1542/peds.2013-0575.
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