title: Apgar score of 0 at 5 minutes and neonatal seizures or serious neurologic dysfunction in relation to birth setting.
abstract: OBJECTIVE
  To examine the occurrence of 5-minute Apgar scores of 0 and seizures or serious neurologic dysfunction for 4 groups by birth setting and birth attendant (hospital physician, hospital midwife, free-standing birth center midwife, and home midwife) in the United States from 2007-2010.
  
  
  METHODS
  Data from the United States Centers for Disease Control's National Center for Health Statistics birth certificate data files were used to assess deliveries by physicians and midwives in and out of the hospital for the 4-year period from 2007-2010 for singleton term births (≥37 weeks' gestation) and ≥2500 g. Five-minute Apgar scores of 0 and neonatal seizures or serious neurologic dysfunction were analyzed for 4 groups by birth setting and birth attendant (hospital physician, hospital midwife, freestanding birth center midwife, and home midwife).
  
  
  RESULTS
  Home births (relative risk [RR], 10.55) and births in free-standing birth centers (RR, 3.56) attended by midwives had a significantly higher risk of a 5-minute Apgar score of 0 (P < .0001) than hospital births attended by physicians or midwives. Home births (RR, 3.80) and births in freestanding birth centers attended by midwives (RR, 1.88) had a significantly higher risk of neonatal seizures or serious neurologic dysfunction (P < .0001) than hospital births attended by physicians or midwives.
  
  
  CONCLUSIONS
  The increased risk of 5-minute Apgar score of 0 and seizures or serious neurologic dysfunction of out-of-hospital births should be disclosed by obstetric practitioners to women who express an interest in out-of-hospital birth. Physicians should address patients' motivations for out-of-hospital delivery by continuously improving safe and compassionate care of pregnant, fetal, and neonatal patients in the hospital setting.
authors.affiliation: Department of Obstetrics and Gynecology, Weill Medical College of Cornell University, New York, NY.
authors.forename: Amos
authors.initials: A
authors.lastname: Grünebaum
authors.forename: Laurence B
authors.initials: LB
authors.lastname: McCullough
authors.forename: Katherine J
authors.initials: KJ
authors.lastname: Sapra
authors.forename: Robert L
authors.initials: RL
authors.lastname: Brent
authors.forename: Malcolm I
authors.initials: MI
authors.lastname: Levene
authors.forename: Birgit
authors.initials: B
authors.lastname: Arabin
authors.forename: Frank A
authors.initials: FA
authors.lastname: Chervenak
mesh_terms: D000328:Adult; D001034:Apgar Score; D016550:Birthing Centers / Q000706:statistics & numerical data*; D003696:Delivery Rooms / Q000706:statistics & numerical data*; D036861:Delivery, Obstetric / Q000706:statistics & numerical data*; D005260:Female; D006700:Home Childbirth / Q000706:statistics & numerical data*; D006801:Humans; D007231:Infant, Newborn; D008880:Midwifery / Q000706:statistics & numerical data*; D009422:Nervous System Diseases / Q000453:epidemiology*; D009774:Obstetrics / Q000706:statistics & numerical data*; D011247:Pregnancy; D012306:Risk; D012640:Seizures / Q000453:epidemiology*; D014481:United States / Q000453:epidemiology; D055815:Young Adult
keywords: Apgar score; birth center; homebirth; hospital birth; neonatal seizures; patient safety