New Research: Perspectives on Risk

The March 22, 2017 issue of Birth included the study: “Perspectives on risk: Assessment of risk profiles and outcomes among women planning community birth in the United States, ” by Bovbjerg, Cheyney, Brown, Cox, and Leeman that examined different well-accepted risk factors and see how those impacted outcomes. The risk factors they considered were maternal age, high BMI, primiparity (being a first-time mother), postdates pregnancy, pre-eclampsia, gestational diabetes, twins, breech presentation, and history of cesarean birth. The outcomes they examined were transfers of care, hospitalization, perineal trauma, postpartum hemorrhage, cesarean birth, very low APGAR scores, and fetal/neonatal mortality. They compared groups with the individual risk factors to multiparous women with no history of cesarean birth.

Some of the results were not surprising, though the magnitude, perhaps, was. Babies in breech presentation, for example, had a fetal/neonatal risk of death over 8 times greater than the comparison group. And while women planning their first vaginal birth after cesarean birth have poorer outcomes than primiparas, women with a previous cesarean birth who have a previous history of vaginal birth, actually had better outcomes than first-time mothers. Age, BMI, and diet-controlled gestational diabetes all had low rates of increased risk, whereas pre-eclampsia and postdates pregnancies did show significantly increased risk.

While it is not possible to use these findings to make individual predictions, it is an important study in terms of informing community birth practice. This affirms the long-held belief that home birth is safe for low-risk women. And it takes it a step further by examining what, exactly, low-risk means. Kudos to the research team and MANA Division of Research for adding to our body of evidence for safe home birth practice.