Neonatologists live in a world of constant monitoring, frequent labs, and the watchful eye of well-trained nurses. Those of us who also cover well baby nurseries suffer fear and trepidation outside the safety net of the NICU. On the other hand, we sometimes upset parents by enacting care plans designed to ensure newborn safety: antibiotics, tube feeding, phototherapy, transfusions, etc. Many of these interventions have contributed to improved neonatal survival; however, changing science has put some common interventions on the Choosing Wisely list of unnecessary medical tests and treatments.
In the COVID-19 pandemic, we have a front row seat to watch how the general population reacts to changing science. As our understanding of masking, viral shedding, therapeutics, and vaccine effects has changed over time, the publicized shifts among medical experts have contributed to a loss of confidence in the medical system. I see similar feelings from parents of NICU patients when they perceive the baby’s therapy is unnecessary, and I know many pregnant women feel the same about giving birth in a hospital. They claim hospital-based births allow OBs to monitor too much, intervene too quickly, and otherwise stand in the way of a “natural” birthing experience.
In this month’s Pediatrics in Review, Dr. Kristi Watterberg’s In Brief, “Planned Home Birth,” highlights the growing trends of home births and the AAPs recommendations for providing optimal health care in the home environment. Dr. Watterberg shares data that illustrates increased mortality for planned home births compared to planned hospital births.
It may be hard for a pediatrician to comprehend why any parent would choose a home birth if they know it is associated with increased neonatal mortality, yet a search for home birth on Facebook yields more than 100 groups, mostly private. I suspect most of these groups are managed by home-birth advocates who minimize the risks of home birth, just as many voices minimizing the risks of COVID-19 encourage parents to send their unvaccinated children into high-risk environments without masks. The reality is that COVID-19 outcomes in children are generally good; but unfortunately, some children suffer severe complications and death. The same can be said for home births: outcomes are generally good; but unfortunately, some infants suffer severe complications and death.
I realize my perspective is biased from seeing too many disasters after delivering at home without a NICU team immediately ready to respond to rare complications. However, the AAP encourages us to handle these situations with understanding and mutual respect. As pediatricians, we must encourage those planning for and supporting home births to follow the AAP’s guidance to provide quality healthcare to the newborn born at home to optimize outcomes and minimize risk.