title: Perinatal outcomes of low-risk planned home and hospital births under midwife-led care in Japan.
abstract: OBJECTIVE
  It has not been extensively studied whether planned home and planned hospital births under primary midwife-led care increase risk of adverse events among low-risk women in Japan.
  
  
  METHODS
  A retrospective cohort study was performed to compare perinatal outcome between 291 women who were given primary midwife-led care during labor and 217 women who were given standard obstetric shared care. Among 291 women with primary midwife-led care, 168 and 123 chose home deliver and hospital delivery, respectively. Perinatal outcomes included length of labor of 24 h or more, augmentation of labor pains, delivery mode, severe perineal laceration, postpartum hemorrhage of 1000 mL or more, maternal fever of 38°C or more and neonatal asphyxia (Apgar score, <7). Analysis was by intention to treat.
  
  
  RESULTS
  The incidence of transfer from primary midwife-led care to obstetric shared care was 27% (77 women) mainly due to failure of labor progress (21%, 16 women), postpartum hemorrhage (19%, 15 women) and non-reassuring fetal status (19%, 15 women). Significantly higher incidence of transfer to obstetric shared care from primary midwife-led care was seen among women who chose hospital delivery compared with women who chose home delivery (34 vs 21%, P = 0.011). There were no significant differences in the incidence of adverse perinatal outcomes between women with obstetric shared care and women with primary midwife-led care (regardless of being hospital delivery or home delivery).
  
  
  CONCLUSIONS
  Approximately one-quarter of low-risk women with primary midwife-led care required obstetric care during labor or postpartum. However, primary midwife-led care during labor at home and hospital for low-risk pregnant women was not associated with adverse perinatal outcomes in Japan.
authors.affiliation: Department of Obstetrics and Gynecology, Japanese Red Cross Katsushika Maternity Hospital.
authors.forename: Yoshie
authors.initials: Y
authors.lastname: Hiraizumi
authors.forename: Shunji
authors.initials: S
authors.lastname: Suzuki
mesh_terms: D000328:Adult; D036861:Delivery, Obstetric / Q000706:statistics & numerical data*; D005260:Female; D006700:Home Childbirth / Q000706:statistics & numerical data*; D006801:Humans; D007564:Japan / Q000453:epidemiology; D008880:Midwifery / Q000706:statistics & numerical data*; D007744:Obstetric Labor Complications / Q000453:epidemiology*; D011247:Pregnancy; D012189:Retrospective Studies
keywords: Japan; home births; midwife-led care; perinatal outcomes