Perinatal mortality and morbidity up to 28 days after birth among 743 070 low-risk planned home and hospital births: a cohort study based on three merged national perinatal databases

Abstract

Objective To compare rates of adverse perinatal outcomes between planned home births versus planned hospital births.Design A nationwide cohort study.Setting The Netherlands.Population Low-risk women in midwife-led care at the onset of labour.Methods Analysis of national registration data.Main outcome measures Intrapartum and neonatal death, Apgar scores, and admission to a neonatal intensive care unit (NICU) within 28 days of birth.Results Of the total of 814 979 women, 466 112 had a planned home birth and 276 958 had a planned hospital birth. For 71 909 women, their planned place of birth was unknown. The combined intrapartum and neonatal death rates up to 28 days after birth, including cases with discrepancies in the registration of the moment of death, were: for nulliparous women, 1.02& for planned home births versus 1.09& for planned hospital births, adjusted odds ratio (aOR) 0.99, 95% confidence interval (95% CI) 0.79-1.24; and for parous women, 0.59& versus 0.58&, aOR 1.16, 95% CI 0.87-1.55. The rates of NICU admissions and low Apgar scores did not significantly differ among nulliparous women (NICU admissions up to 28 days, 3.41& versus 3.61&, aOR 1.05, 95% CI 0.92-1.18). Among parous women the rates of Apgar scores below seven and NICU admissions were significantly lower among planned home births (NICU admissions up to 28 days, 1.36 versus 1.95&, aOR 0.79, 95% CI 0.66-0.93).Conclusions We found no increased risk of adverse perinatal outcomes for planned home births among low-risk women. Our results may only apply to regions where home births are well integrated into the maternity care system.

Outcomes for the First Year of Ontario's Birth Center Demonstration Project

“…We compared transport rates to those demonstrated elsewhere in the literature on low‐risk out‐of‐hospital births. Fetal and maternal clinical events that were markers of severe morbidity were identified based on review of the literature and assessment of what could be measured within the BIS or via data linkage to CIHI 2, 5, 7, 12, 23, 24, 25, 26, 27, 28, 29, 30. Specifically for maternal morbidity, we looked for uterine rupture, eclampsia, severe hemorrhage, obstetric shock, obstetric embolism, cerebrovascular event, cardiovascular events, renal failure, fourth‐degree lacerations, sepsis, ventilator support, intensive care unit admission, or transfer to hospital for a nonlabor related event.…”

“…International literature supports the safety of an out‐of‐hospital birth in a low‐risk population in systems in which an out‐of‐hospital birth is well integrated in a broader maternal‐child health program 2, 3, 4, 5, 6, 7, 8, 9, 10, 11. The safety of a planned home birth under midwifery care in Ontario has been established 12, 13.…”

Planned Out-of-Hospital Birth and Birth Outcomes

“…Studies from Europe have shown that out-ofhospital birth can be a safe option for women and their babies when the risk of complications is low. [28][29][30] The European Union defines uniform standards for the education and training of mid-wives, 31 whereas the United States takes a piecemeal approach to the training and credentialing of out-of-hospital birth attendants. The American College of Nurse-Midwives and the North American Registry of Midwives recommend that midwives should at minimum meet the standards of midwifery established by the International Confederation of Midwives (ICM), which include completion of a formal midwifery education program, national certification, and licensure in the local jurisdiction of practice.…”

Is Planned Home Birth Safe? What Do the Societies Say?

“…İsveç, ABD, Finlandiya, İzlanda, Avustralya ve Norveç gibi ülkelerde ise evde doğum oranları %1'in altın-dadır (Tablo 3). [6][7][8][9][10][11][12][13][14][15][16] AMERİKAN OBSTETRİ VE JİNEKOLOJİ DERNEĞİ KOMİTE GÖRÜŞÜ ACOG'un Şubat 2011 tarih ve 476 sayılı kararı evde doğum uygulamaları ile ilgilidir. 17 ACOG'un planlı evde doğum ile ilgili özet kararları:…”