Hospitals still safest place to give birth during pandemic, AAP says
Hospitals and accredited birth centers remain the safest place to give birth during the COVID-19 pandemic, the AAP said. For women who still plan to have a baby at home, the AAP updated its safety recommendations for in-home births in a new policy statement, while continuing to recommend against the practice due to safety concerns.
In-home births are associated with a twofold to threefold increase in infant mortality, according to the AAP. They carry an additional risk during the pandemic, especially in areas with high COVID-19 case counts, because first responders may not be able to get to mothers and infants in time if there is an emergency, said Kristi Watterberg, MD, FAAP, professor of pediatrics at the University of New Mexico, who authored the policy statement with the AAP’s Committee on Fetus and Newborns, which she chairs.
“I worry about that a lot more than I'm worried about an increase in exposure to COVID-19 for moms in the hospital,” Watterberg told Healio. “I'm sure all hospitals are like ours, taking great pains to try and avoid any kind of contact.”
The APP recommends that home births meet several criteria, including that two care providers be present, with at least one who is responsible for the care of the newborn and who can resuscitate the infant if needed.
The policy statement recommends following established guidelines on perinatal care. These include recommendations to provide transitional care, emphasizing keeping the infant warm and conducting a physical examination; monitoring the infant for early-onset sepsis; conducting a glucose screening; providing prophylaxis against gonococcal ophthalmia; giving a perinatal dose of vitamin K; vaccinating against hepatitis B; assessing the infant’s feeding; screening for hyperbilirubinemia; administering hearing and pulse oximetry screenings; screening newborns in accordance with state mandates; and provisioning for follow-up care.
“These are the things you cannot miss because in a hospital, these systems are in place — the hearing screen check, the heart screen check, the physical examination, all these things are done. As a health care provider, you just have to check the boxes, you don't have to worry about if all the boxes are there,” Watterberg said.
Watterberg noted that planned in-home births in the United States have been linked to an absolute risk increase of one to two deaths per 1,000 live births. Although hospitals are currently overwhelmed by a rising amount of COVID-19 cases, she reiterated that they remain a safer option.
“I think everybody, including the hospitals, is doing all they can to keep moms and their babies separate from people that might be infectious, having different people take care of moms and babies than take care of ER or the ICU, all down the line.” she said. “I think that they're trying very, very hard to make sure that moms do not have an increase in risk of acquiring coronavirus from delivery in the hospital.” – by Ken Downey Jr.
Disclosure: Watterberg reports no relevant financial disclosures.