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    Home birth after prior cesarean: What are the risks?

    Home births, compared to delivery in the hospital, pose significantly elevated and preventable neonatal risks, according to research findings by Amos Grünebaum, MD, and Frank A Chervenak, MD, of Weill Medical College of Cornell University, New York, New York. These risks include an Apgar score of 0 and seizure or serious neurologic dysfunction.

    In the first prize, award-winning paper presented by Dr Grünebaum at the American College of Obstetricians and Gynecologists 2016 annual meeting, the researchers conclude that the lack of fetal monitoring and not being able to perform a timely cesarean delivery outside of a hospital setting combine to result in the increased risk.

    “Our study confirms other studies,” comments Dr Grünebaum, Professor and Director of Obstetrics and Chief of Labor & Delivery at Weill Cornell Medicine, “which show that planned home birth in the United States, in this case in women with prior cesarean deliveries, is not safe for neonates when one considers its absolute and relative risks in the context of patient safety.”

    Given the increase of vaginal births after cesarean (VBAC) seen among planned home births, the investigators undertook an evaluation of the risks of an Apgar score of 0 and seizure/serious neurologic dysfunction for neonates of patients who deliver at home with a VBAC. They conducted a retrospective cohort analysis of the Centers for Disease Control and Prevention birth certificate data (2007–2013) for infants at term (>37 weeks) whose birthweight was more than 2499 g and mothers who had had a prior cesarean delivery.

    Related: Home birth: The obstetrician's ethical response

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