Early and total neonatal mortality in relation to birth setting in the United States, 2006-2009

Planned Out-of-Hospital Birth and Birth Outcomes

“…In other, similar studies in which it was not possible to account for intrapartum transfers to the hospital, results similar to ours were reported for neonatal deaths, neonatal seizures, and Apgar scores. 3,6,7,9,18 Out-of-hospital births were also associated with a higher rate of unassisted vaginal delivery and lower rates of obstetrical interventions and NICU admission than in-hospital births, findings that corroborate the results of earlier studies. [3][4][5] These associations follow logically from the more conservative approach to intervention that characterizes the midwifery model of care 8,19 and from the fact that obstetrical interventions are either rare (e.g., induction of labor) 20 or unavailable (e.g., cesarean delivery, whether at home or at a birth center) outside the hospital setting.…”

“…2,5,9 A key shortcoming of prior studies of planned home birth is the classification of births by the eventual rather than the intended place of birth (i.e., intrapartum home-to-hospital transfers were counted as hospital births). 3,7,10 In 2012, the home birth rate in Oregon was 2.4%, which was the highest rate of any state; another 1.6% of women in Oregon delivered at birth centers. 11 Before licensure became mandatory in 2015, Oregon was one of two states in which licensure was not required for the practice of midwifery in out-of-hospital settings.…”

“…2 According to recent U.S. studies of out-of-hospital birth, women planning to deliver at home had lower rates of obstetrical intervention, [3][4][5] and their infants had higher rates of complications and death. 3,6,7 Potential explanations for these findings as they relate to obstetrical interventions include differences in models for obstetrical care (i.e., care provided by an obstetrician, by a certified nurse-midwife, or by certified professional midwife 8 ), in the practices of the birth attendant, in provider and maternal preference for (and the availability of) medical technology, and in maternal characteristics. Few studies have compared outcomes at birth centers with those at other birth settings.…”

A Cost-Effectiveness Analysis of Low Risk Deliveries: A Comparison of Midwives, Family Physicians and Obstetricians

“…It is also unknown whether the findings here are generalizable to MW care in other delivery settings such as homes and birth centres, as outcomes may vary (Grunebaum et al 2014). A potential bias of the study is that lower-risk patients may have self-selected a MW.…”

Authors' reply re: BJOG Debate ‘Home birth is unsafe’

“…There is a strict professional obligation to address this question on evidencebased grounds, and we have done so in several publications. 5,6 We document above how Ms Cohain repeatedly fails to fulfill this professional obligation. The scientific, clinical and ethical dimensions of planned home birth are serious matters.…”