Call to highlight home birth risks as experts warn of ‘silent tragedy’ of disability

While studies have shown an increased risk of a baby dying during a home birth, little has been said about the chance of disability – which can occur due to factors such as oxygen starvation, they argued.

The authors said deprivation of oxygen – medically known as hypoxic ischemic encephalopathy – can lead to cerebral palsy, and motor and cognitive problems that can be detected at school age.

While campaigners in favour of home births focus on the fact women may need less intervention, such as forceps, there has been little focus on the risk of disability.

The authors said “part of the enthusiasm for home birth is related to cost-cutting”, adding: “Couples should be warned of avoidable and foreseeable risks of future child disability.”

Writing in the Journal of Medical Ethics, Professor Julian Savulescu, from the faculty of philosophy at Oxford University, and obstetrician and gynaecologist Associate Professor Lachlan de Crespigny, of the University of Melbourne, said that when problems occur at home there can be a delay in transferring women to hospital.

“Delay in transferring to a tertiary hospital may result in permanent severe disability that will persist for the rest of that person’s life,” they said.

“Vital delays are inevitable in some cases. These can lead to disability, which was avoidable if the delivery had occurred in hospital.”

The authors argue that when labour is obstructed or the baby starts to suffer from lack of oxygen, the “immediate treatment” of the baby is crucial for its immediate and longer term health.

To take an extreme example, the lack of equipment to deal quickly when such events occur at home might result in avoidable quadriplegia, they added.

A 2011 Oxford University study found babies born to first-time mothers who choose a home birth are almost three times more likely to die or suffer a medical complication.

Elizabeth Duff, senior policy adviser at the National Childbirth Trust, said: “Home birth should be considered a mainstream option for women in the UK alongside birth centres and hospital maternity units, provided women have a straightforward pregnancy.”