Gruenebaum et al reviewed neonatal deaths that occurred following home delivery by a midwife of a term singleton pregnancies. The risk of neonatal morbidity or mortality is greater with a home delivery than with hospital delivery even for selected patients. The authors are from Cornell University, Baylor University Houston and Phillips University in Marburg.
Patient selection: singleton term pregnancy, delivered at home by a midwife
Causes of neonatal mortality:
(1) unexpected problems during labor and delivery
(2) intra-uterine infection
(3) congenital anomalies and malformations
where:
• If a problem arises there are fewer resources and trained personnel.
In general:
(1) it is safer to deliver at a hospital
(2) the fetus should be screened for anomalies and malformations prior to delivery
(3) contraindications to home delivery should be observed
(4) the mother should be screened for infection
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