Perinatal mortality and morbidity in a nationwide cohort of 529,688 low-risk planned home and hospital births.
OBJECTIVE
To compare perinatal mortality and severe perinatal morbidity between planned home and planned hospital births, among low-risk women who started their labour in primary care.


METHODS
A nationwide cohort study.


METHODS
The entire Netherlands.


METHODS
A total of 529,688 low-risk women who were in primary midwife-led care at the onset of labour. Of these, 321,307 (60.7%) intended to give birth at home, 163,261 (30.8%) planned to give birth in hospital and for 45,120 (8.5%), the intended place of birth was unknown.


METHODS
Analysis of national perinatal and neonatal registration data, over a period of 7 years. Logistic regression analysis was used to control for differences in baseline characteristics.


METHODS
Intrapartum death, intrapartum and neonatal death within 24 hours after birth, intrapartum and neonatal death within 7 days and neonatal admission to an intensive care unit.


RESULTS
No significant differences were found between planned home and planned hospital birth (adjusted relative risks and 95% confidence intervals: intrapartum death 0.97 (0.69 to 1.37), intrapartum death and neonatal death during the first 24 hours 1.02 (0.77 to 1.36), intrapartum death and neonatal death up to 7 days 1.00 (0.78 to 1.27), admission to neonatal intensive care unit 1.00 (0.86 to 1.16).


CONCLUSIONS
This study shows that planning a home birth does not increase the risks of perinatal mortality and severe perinatal morbidity among low-risk women, provided the maternity care system facilitates this choice through the availability of well-trained midwives and through a good transportation and referral system.
de Jonge
A
A
TNO Quality of Life, Leiden, The Netherlands. ankdejonge@hotmail.com
van der Goes
B Y
BY
Ravelli
A C J
AC
Amelink-Verburg
M P
MP
Mol
B W
BW
Nijhuis
J G
JG
Bennebroek Gravenhorst
J
J
Buitendijk
S E
SE
D005260:Female; D005865:Gestational Age; D006700:Home Childbirth / Q000401:mortality*; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D007363:Intensive Care Units, Neonatal / Q000706:statistics & numerical data; D008423:Maternal Age; D009426:Netherlands / Q000453:epidemiology; D010298:Parity; D054238:Perinatal Mortality; D011247:Pregnancy; D011256:Pregnancy Outcome / Q000453:epidemiology*; D012307:Risk Factors; D012959:Socioeconomic Factors