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Planned Home Compared With Planned Hospital Births in The Netherlands: Intrapartum and Early Neonatal Death in Low-Risk Pregnancies

van der Kooy, Jacoba MD; Poeran, Jashvant MD; de Graaf, Johanna P. MSc; Birnie, Erwin PhD; Denktaş, Semiha PhD; Steegers, Eric A. P. MD, PhD; Bonsel, Gouke J. MD, PhD

doi: 10.1097/AOG.0b013e3182319737
Original Research

OBJECTIVE: The purpose of our study was to compare the intrapartum and early neonatal mortality rate of planned home birth with planned hospital birth in community midwife-led deliveries after case mix adjustment.

METHODS: The perinatal outcome of 679,952 low-risk women was obtained from the Netherlands Perinatal Registry (2000–2007). This group represents all women who had a choice between home and hospital birth. Two different analyses were performed: natural prospective approach (intention-to-treat–like analysis) and perfect guideline approach (per-protocol–like analysis). Unadjusted and adjusted odds ratios (ORs) were calculated. Case mix was based on the presence of at least one of the following: congenital abnormalities, small for gestational age, preterm birth, or low Apgar score. We also investigated the potential risk role of intended place of birth. Multivariate stepwise logistic regression was used to investigate the potential risk role of intended place of birth.

RESULTS: Intrapartum and neonatal death at 0–7 days was observed in 0.15% of planned home compared with 0.18% in planned hospital births (crude relative risk 0.80, 95% confidence interval [CI] 0.71–0.91). After case mix adjustment, the relation is reversed, showing nonsignificant increased mortality risk of home birth (OR 1.05, 95% CI 0.91–1.21). In certain subgroups, additional mortality may arise at home if risk conditions emerge at birth (up to 20% increase).

CONCLUSION: Home birth, under routine conditions, is generally not associated with increased intrapartum and early neonatal death, yet in subgroups, additional risk cannot be excluded.

LEVEL OF EVIDENCE: II

Home birth, under routine conditions, generally is not associated with more intrapartum and early neonatal death; yet, in subgroups, additional risk cannot be excluded.

From the Department of Obstetrics and Gynaecology, Division of Obstetrics & Prenatal Medicine, and the Department of Public Health, Erasmus MC, the Institute of Health Policy and Management, and Rotterdam Midwifery Academic (Verloskunde Academie Rotterdam), Rotterdam, The Netherlands.

This analysis was carried out as part of the Signalement-studie, a national report to prioritize perinatal research on behalf of ZonMw (The Netherlands Organisation for Health Research and Development grant no. 50-50150-98-011). The Netherlands Perinatal Registry, Utrecht, the Netherlands, kindly provided permission for the data analyses involved.

The authors thank Mrs E. Joziasse-Fitzpatrick for editing the text.

Presented at the Gynaecongres for the Dutch Society of Obstetrics and Gynaecology, November 9–11, 2010, Arnhem, The Netherlands.

Corresponding author: Jacoba van der Kooy, Department of Obstetrics and Gynaecology, Division of Obstetrics & Prenatal Medicine, Room HS-408, Erasmus MC, PO Box 2040, 3000 CA Rotterdam, The Netherlands; e-mail: j.vanderkooy@erasmusmc.nl.

Financial Disclosure The authors did not report any potential conflicts of interest.

© 2011 by The American College of Obstetricians and Gynecologists. Published by Wolters Kluwer Health, Inc. All rights reserved.