Enhancing safety and outcomes in home births: a detailed response to concerns and recommendations
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Amos Grünebaum
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Frank A. Chervenak
To the Editor,
Thank you for your insightful letter regarding “Why Do Women Choose Home Births” [1]. We agree with your points and appreciate the depth of analysis you provided. Here is our point-by-point response to your correspondence:
Increase in home births: your observation of the 60 % increase in home births from 2016 to 2023 highlights a significant trend. As we discussed, this rise indeed necessitates a closer examination of the factors driving this choice and its implications on maternal and infant health.
Higher rates of newborn illness and mortality: you correctly point out that non-adherence to ACOG guidelines has led to higher rates of newborn illness and mortality. In the US, home birth midwives often operate without strict guidelines and are not required to adhere to the standards set by the American College of Obstetricians and Gynecologists (ACOG). This lack of regulation can result in poor outcomes, as midwives may not always follow the best practices for candidate selection and risk management. Ensuring that home birth midwives follow these guidelines (or any guidelines for that matter) is crucial for mitigating these risks and improving outcomes.
Reasons for choosing home births: the elements you mentioned, such as the desire for a natural birthing process, negative hospital experiences, and concerns about hospital safety during the COVID-19 pandemic, are indeed among the reasons why many women opt for home births. These factors, combined with cognitive biases, significantly influence their decision-making process.
Cognitive biases in decision-making: your application of Daniel Kahneman’s decision-making theories is particularly insightful. Cognitive biases can indeed lead individuals to prioritize personal experiences over potential risks, and understanding this can help in guiding better decision-making for expectant mothers.
Need for adherence to ACOG and other guidelines: emphasizing the adherence to ACOG recommendations is essential. As you rightly pointed out, strict adherence to these guidelines can help ensure better outcomes for both mothers and infants during home births. Moreover, there are numerous safety protocols beyond ACOG guidelines that are not typically implemented in home birth settings. These include absence of immediate access to emergency medical care, inability for continuous fetal monitoring, no access to adequate pain control, no access to expeditious operative delivery, inadequate experience and amount of personnel to care for patients in an emergency, and no advanced maternal and neonatal resuscitation equipment. The absence of these additional safety measures further underscores the risks associated with home births. Implementing these protocols, alongside ACOG guidelines, could significantly reduce the rates of complications and improve overall outcomes for home births. In addition many home births include contraindicated high-risk pregnancy conditions that necessitate adherence to guidelines including nulliparity, twins, prior cesarean delivery, post-dates, and macrosomia, to name just a few.
Methodological approaches and AI tools: your caution against relying solely on AI tools like ChatGPT for data synthesis is well-founded. The complexity and nuances of the subject require thorough independent data analysis and interpretation to avoid methodological errors and biases.
Future research and protocol improvement: addressing the flaws in current protocols and improving methodological approaches are vital steps forward. Further research into how cognitive biases affect decision-making can indeed contribute to safer outcomes for women considering home births.
Your letter brings to light critical aspects of the rising trend in home births and offers valuable recommendations for improving safety and outcomes. Thank you for your contribution to this important discussion.
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Research ethics: There is no research involved here.
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Informed consent: Not applicable.
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Author contributions: All authors contributed the same.
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Competing interests: The authors state no conflict of interest.
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Research funding: None declared.
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Data availability: Not applicable.
References
1. Daungsupawong, H, Wiwanitkit, V. Why do women choose home births: correspondence. J Perinat Med 2024;52:793.10.1515/jpm-2024-0227Suche in Google Scholar PubMed
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Artikel in diesem Heft
- Frontmatter
- Corner of Academy
- The IAPM New York 2024 declaration on professional responsibility and abortion
- Review
- Common foot and ankle disorders in pregnancy: the role of diagnostic ultrasound
- Opinion Paper
- Reproductive genetic carrier screening in pregnancy: improving health outcomes and expanding access
- Original Articles – Obstetrics
- “It feels like you have to choose one or the other”: a qualitative analysis of obstetrician focus groups on periviability counseling
- Expectant management vs. cerclage in cases with prolapsed or visible membranes in the second trimester: is 24 weeks gestation threshold critical?
- Prevention of preterm birth in twin-to-twin transfusion syndrome: a systematic review and network meta-analysis
- Accidental uterine extensions in cesarean deliveries – outcome of subsequent pregnancy
- Effect of acidic vaginal pH on the efficacy of dinoprostone (PGE2) vaginal tablet for labor induction in full term pregnant women: a randomized controlled trial
- Oligohydramnios at term in the high-risk population – how severe is severe?
- Original Articles – Fetus
- Assessment of the fetal thymic-thoracic ratio in pregnant women with intrahepatic cholestasis: a prospective case-control study
- Congenital diaphragmatic hernia treated via fetal endoscopic tracheal occlusion improves outcome in a middle-income country
- Fetal bradyarrhythmias: classification, monitoring and outcomes of 40 cases at a single center
- Deep learning based detection and classification of fetal lip in ultrasound images
- Original Articles – Neonates
- Cytomegalovirus congenital infection: long-term outcomes in a valaciclovir treated population
- Does placental VEGF-A protein expression predict early neurological outcome of neonates from FGR complicated pregnancies?
- Letters to the Editor
- Why do women choose home births: correspondence
- Enhancing safety and outcomes in home births: a detailed response to concerns and recommendations
