Homebirth does not protect against serious maternal infections

Homebirth advocates like to tout the many “advantages” of giving birth at home. High on the list is limiting exposure to hospital acquired infections, and since only your “own germs” are in your home, you are protected.

Yes, you are protected from hospital acquired infections, but the most dangerous infectious agents are actually those that live inside the mother, not the ones in the hospital. Consider that for newborns both Group B strep and herpes virus represents potentially deadly threats. And both Group B strep and herpes virus are infectious agents carried by the mother. In other words, the most deadly infectious threat to the baby is the mother herself.

For mothers, the most common infectious risk is a uterine infection. Once again the infectious agent is usually a bacteria living in the vagina. Homebirth advocates like to fling accusations about women who contract life threatening sepsis at home and are fond of pointing out horror stories like the unfortunate woman in Florida who ended up losing parts of multiple limbs due to Group A strep (“flesh eating” bacteria) sepsis. But what they don’t realize is that approximately 90% of cases of Group A strep sepsis are acquired outside the hospital because the bacteria lives in the community. Usually it is harmless, but when it invades a wound (like the raw surface of the inside of the uterus after birth), the results can be disastrous.

It appears that this has happened in a small Texas town. According to the local paper:

A few weeks ago, a perfectly healthy Katy gave birth to daughter Arielle, only to experience an intense and prolonged pain after the birth.

… Doctors at Kingwood Medical Center eventually discovered the new mom had a Streptococcal A infection that had aggressively invaded her body.

As a result, Katy has experienced multiple organ failure and is unconscious. Surgery last week involved the removal of several sepsis organs. She is currently on a ventilator and is receiving dialysis.

Katy had had an eight hour, drug-free, intervention free labor and delivered a 10 pound baby girl … in a planned homebirth.

Of course, the result may not have been any different had Katy given birth in the hospital, since she would have brought the bacteria in with her. And that is the important point to keep in mind. While hospital acquired infections are a serious problem for the elderly and the immuno-compromised, they are far less common in obstetric care. During childbirth, the bacteria and viruses that pose the greatest threat to babies and mothers are those carried by the mother herself.

Homebirth does not offer protection against serious neonatal and maternal infections, because the most dangerous “germs” are “your own germs at home.”

Amy Tuteur is an obstetrician-gynecologist who blogs at The Skeptical OB.

Submit a guest post and be heard.

Comments are moderated before they are published. Please read the comment policy.

  • JLP

    Can’t figure out how to post the link, but in 2009 there was a nasty outbreak of MRSA affecting 19 infants and 18 mothers at Beth Israel Deaconess in Boston, MA. Any search engine should bring up the news story on Boston.com

    But that’s anecdotal, as is the story of the Texas mother with the Group A strep infection.

    It would be interesting to see actual infection rates for Group B strep and herpes in pregnant women, as well as transmission rates to infants by infected women, treated vs. untreated. It would also be interesting to see infection rates in both women and newborns for pathogens other than Group B strep and herpes, like MRSA and Group A strep.

  • http://www.drjshousecalls.blogspot.com Dr. Mary Johnson

    It amazes me how many potential Mothers have NO CLUE whatsoever about the risks of Group B Strep – and how much misinformation is out there:

    http://drjshousecalls.blogspot.com/2010/01/on-fox-8s-recent-irresponsible-foray.html

    • Doc99

      These are no doubt the same Moms who get their medical advice from Don Imus and Jenny McCarthy.

  • JLP

    >>It amazes me how many potential Mothers have NO CLUE whatsoever about the risks of Group B Strep – and how much misinformation is out there>>

    Dr. Johnson:

    I read the story and your links. Very sad, especially the family’s attacks on the hospital’s protocols. Hard to accept a poor outcome when it’s your kid, but these are supposedly medical professionals (nurses) themselves so this is particularly outrageous.

    Unfortunately, journalists generally report science and medicine with little curiosity about inconsistencies and overall poor understanding of concepts.

    It’s interesting that nowhere in any of the stories was there any mention of when the baby contracted meningitis. Ambiguous at best, though news stories one week after the quads’ birth stated all the babies were doing well. One news story mentioned that Lillian (the baby who died) actually went home first. If that’s true, this is more likely a case of late-onset GBS – and if that’s the case, she may not even have been infected by her mother.

    As for women having home births, I agree midwives should routinely educate and offer GBS testing. While I think it’s ridiculous to recommend garlic and homeopathy treatment, I suspect some midwives are quite capable of treating with IV antibiotics. After all, one of my neighbors, a nurse practitioner, routinely administers IV antibiotics to patients in their homes.

  • Surgical Resident

    “As for women having home births, I agree midwives should routinely educate and offer GBS testing. While I think it’s ridiculous to recommend garlic and homeopathy treatment, I suspect some midwives are quite capable of treating with IV antibiotics. After all, one of my neighbors, a nurse practitioner, routinely administers IV antibiotics to patients in their homes.”

    JLP please remember that giving an antibiotic is relatively easy. The actual decision to treat with antibiotics and which ones to use are what require a clinician. In addition, I know of few PA’s and NP’s that would start IV abx without a MD’s approval.

  • JLP

    >>The actual decision to treat with antibiotics and which ones to use are what require a clinician.>>

    Well, sure, if we’re talking about treating with antibiotics in general for an established infection. This situation involves testing for GBS (not an unknown) and prophylactic (not therapeutic) antibiotic administration. And, as Dr. Johnson pointed out, there are well-established protocols for diagnosis and treatment of GBS positive women.

    >>In addition, I know of few PA’s and NP’s that would start IV abx without a MD’s approval.>>

    Do you know of any NPs or PAs working as midwives?

  • http://www.midwifeann.com Ann Olsen, LM

    As a licensed midwife in Washington State attending home and birth center births I routinely test all pregnant women in my practice for group B strep, and if they are positive, administer IV antibiotics during labor per the CDC guidelines. I am trained to offer this care and am not required to consult with a physician.

  • Surgical Resident

    my post was in reference to NP’s giving abx to people at home, not a mid wife giving abx for prophylactic reasons. That was how I interrupted JLP’s last paragraph.

  • JLP

    >>my post was in reference to NP’s giving abx to people at home, not a mid wife giving abx for prophylactic reasons.>>

    Ah. Well, I thought this discussion was about the feasibility of giving IV antibiotics to GBS+ women who elect homebirths. I assumed at least some midwives are qualified to prescribe and administer IV antibiotics, as this is done by NPs and PAs and I know at least some midwives are also NPs. I am glad an actual midwife has joined this discussion.

  • Caryn in Kingwood

    I live around and work IN the Kingwood Texas area where Katy had her baby. We are all concerned that no-one seems to know where she contracted this Strep A. Can anyone give a clue to where she may have caught it? I did notice in her picture that she had fake nails, and I was thinking maybe the nail salon….any help would be great! Thanks-

  • mindy

    I had my Kids @ home and wouldn’t CHANGE a THING!

Most Popular