Women who choose to give birth at home may be increasing the risk of neonatal complications, given a failure in some cases to prepare for the worst.

In a retrospective study of babies born in 2008, investigators from Oregon Health and Science University and the University of California at San Francisco found that homebirth nearly doubled the relative risk of an Apgar score--a quick evaluation of a newborn based on appearance, pulse, grimace, activity, and respiration--of four or lower on the 10-point scale. An Apgar score of 7 is considered normal, by comparison.

Babies born at home were also more than three times likely to experience neonatal seizure, which in rare cases may lead to cerebral palsy, developmental impairment, and infant death. Investigator Yvonne W. Cheng and her colleagues compared more than 12,000 planned home births with some 2 million hospital births.

Although educated and married white women over age 35 were most likely to choose home birth, the researchers controlled for age, race, gestational age at birth, among other factors. The home birth mothers in the study were less likely than others to experience induced labor or an assisted delivery, and researchers found that home births attended by certified nurse-midwives yielded complication rates not much different from hospital births. Nurse-midwives presided over more than a quarter of these home births.

“It’s not necessarily so that home births are bad, but women need to think about the trade-offs,” Cheng, of the University of California, San Francisco School of Medicine, said a statement. “Home births have fewer interventions, but the baby is at higher risk. And obstetric problems are often emergencies.”

Nationally, home births account for fewer than one percent of all deliveries but are rising quickly, climbing 50 percent from 2004 to 2011, according to the U.S. Centers for Disease Control and Prevention.

Many midwives ardently defend the safety of home births, stressing that pregnant women choosing to deliver at home should do so with an emergency hospitalization plan in place. The Journal of MIdwifery & Women’s Health offers tips for planning for hospitalization, should emergency care be needed.

Although seemingly obvious, midwives stress that transportation to the nearest hospital emergency room might include the forethought to keep the car filled with gas, for example. Other items include:

Large-sized under pads

• Giving Birth in Place: A Guide to

• Baby blankets with plastic backing Emergency Preparedness for Childbirth

• Newborn hat

• 4 bath towels

• Instructions for adult and baby

• Baby-sized bulb syringe

• Small bottle of isopropyl alcohol cardiopulmonary resuscitation (CPR)

• Clothing

• Box of disposable sterile gloves

• Emergency contact list

• Disposable diapers

• Small bottles of hand sanitizer

• Scissors and white shoe laces that

• A package of large cotton

• Large sanitary pads have been in boiling water for balls

• Flashlight (that doesn’t require batteries) 10 minutes then wrapped in a sterile • A hot water bottle to keep

• Acetaminophen (Tylenol) or glove (for tying and cutting the

• Mom prepared to breastfeed

•ibuprofen (Advil)

Source: Cheng, Yvonne W., Snowden, Jonathan M., King, Tekoa L., Caughey, Aaron B., Selected Perinatal Outcomes Associated With Planned Home Births In The United States. AJOG. 2013.