Researchers: Chen Stein Zamir ¹, Nitza Abramson ¹, Shoob Hanna¹

Background: In high-income settings, homebirth generally refers to planned birth at home, attended by a skilled health professional.

Objectives: To describe rates and trends of planned homebirths, assess maternal characteristics and evaluate compliance with recommendations for newborn screening and routine childhood vaccinations.

Method: A retrospective case-control study of all livebirths reported in the Jerusalem District (JD), Israel, 2016-2023. Maternal and infant characteristics, compliance with newborn screening and vaccinations in planned homebirth infants compared to age-matched infants born in-hospital.

Findings: During 2016-2023, 0.56% of livebirths in the JD (1623/290,458) were planned homebirths. The homebirths rate increased since 2020 (Covid-19 pandemic), from 0.45% in 2016-2019 to 0.66% in 2020-2023. Compared to hospital-born controls, homebirth infants had higher birth weight; lower rate of firstborns (22.4% vs. 27.5 %) and higher Jewish ethnicity rate (100% vs. 82 %). Homebirth mothers were older (median age 32 vs. 29), more likely non-Israeli born (mainly North American) with higher socioeconomic rank of residence (median 5 vs. 2). The newborn screening rate was lower in homebirth infants (73.6% vs. 99.5%). The rate of registration to well-baby clinics was also lower (47.2% vs. 92.9%). Routine infant vaccinations rates were also markedly decreased (30% coverage for DTaP3 and MMRV) in homebirth infants.

Conclusions: The planned homebirth rates increased during the study years. Characteristics of homebirth and in-hospital birth mothers and infants differed. Utilization rates of recommended health measures among homebirth infants are lower than infants born in-hospital.

Recommendations: Newborn screening is essential in early detection of congenital syndromes and vaccinations are essential in infection prevention. Our findings may provide vital information and guidance to the health professionals attending homebirths. These include mainly midwives and physicians, as well as health professionals in the community and hospitals who are key players in promoting acceptance of the recommended care for newborns and infants.

Research end date: 12/2024