Outcomes of planned home births in Washington State: 1989-1996.
OBJECTIVE
To determine whether there was a difference between planned home births and planned hospital births in Washington State with regard to certain adverse infant outcomes (neonatal death, low Apgar score, need for ventilator support) and maternal outcomes (prolonged labor, postpartum bleeding).


METHODS
We examined birth registry information from Washington State during 1989-1996 on uncomplicated singleton pregnancies of at least 34 weeks' gestation that either were delivered at home by a health professional (N = 5854) or were transferred to medical facilities after attempted delivery at home (N = 279). These intended home births were compared with births of singletons planned to be born in hospitals (N = 10,593) during the same years.


RESULTS
Infants of planned home deliveries were at increased risk of neonatal death (adjusted relative risk [RR] 1.99, 95% confidence interval [CI] 1.06, 3.73), and Apgar score no higher than 3 at 5 minutes (RR 2.31, 95% CI 1.29, 4.16). These same relationships remained when the analysis was restricted to pregnancies of at least 37 weeks' gestation. Among nulliparous women only, these deliveries also were associated with an increased risk of prolonged labor (RR 1.73, 95% CI 1.28, 2.34) and postpartum bleeding (RR 2.76, 95% CI 1.74, 4.36).


CONCLUSIONS
This study suggests that planned home births in Washington State during 1989-1996 had greater infant and maternal risks than did hospital births.
Pang
Jenny W Y
JW
Department of Epidemiology, University of Washington School of Public Health and Community Medicine, Seattle, Washington 98195, USA. jwpang@u.washington.edu
Heffelfinger
James D
JD
Huang
Greg J
GJ
Benedetti
Thomas J
TJ
Weiss
Noel S
NS
D000328:Adult; D001034:Apgar Score; D015331:Cohort Studies; D003696:Delivery Rooms / Q000706:statistics & numerical data*; D005260:Female; D006700:Home Childbirth / Q000401:mortality / Q000706:statistics & numerical data*; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007226:Infant Mortality / Q000639:trends*; D007231:Infant, Newborn; D016555:Matched-Pair Analysis; D008875:Middle Aged; D007744:Obstetric Labor Complications / Q000175:diagnosis / Q000453:epidemiology*; D010298:Parity; D011247:Pregnancy; D011256:Pregnancy Outcome; D015995:Prevalence; D012042:Registries; D012127:Respiratory Distress Syndrome, Newborn / Q000175:diagnosis / Q000453:epidemiology*; D018570:Risk Assessment; D012307:Risk Factors; D014861:Washington / Q000453:epidemiology