title: Early and total neonatal mortality in relation to birth setting in the United States, 2006-2009.
abstract: OBJECTIVE
  We examined neonatal mortality in relation to birth settings and birth attendants in the United States from 2006 through 2009.
  
  
  METHODS
  Data from the Centers for Disease Control and Prevention-linked birth and infant death dataset in the United States from 2006 through 2009 were used to assess early and total neonatal mortality for singleton, vertex, and term births without congenital malformations delivered by midwives and physicians in the hospital and midwives and others out of the hospital. Deliveries by hospital midwives served as the reference.
  
  
  RESULTS
  Midwife home births had a significantly higher total neonatal mortality risk than deliveries by hospital midwives (1.26 per 1000 births; relative risk [RR], 3.87 vs 0.32 per 1000; P < .001). Midwife home births of 41 weeks or longer (1.84 per 1000; RR, 6.76 vs 0.27 per 1000; P < .001) and midwife home births of women with a first birth (2.19 per 1000; RR, 6.74 vs 0.33 per 1000; P < .001) had significantly higher risks of total neonatal mortality than deliveries by hospital midwives. In midwife home births, neonatal mortality for first births was twice that of subsequent births (2.19 vs 0.96 per 1000; P < .001). Similar results were observed for early neonatal mortality. The excess total neonatal mortality for midwife home births compared with midwife hospital births was 9.32 per 10,000 births, and the excess early neonatal mortality was 7.89 per 10,000 births.
  
  
  CONCLUSIONS
  Our study shows a significantly increased total and early neonatal mortality for home births and even higher risks for women of 41 weeks or longer and women having a first birth. These significantly increased risks of neonatal mortality in home births must be disclosed by all obstetric practitioners to all pregnant women who express an interest in such births.
authors.affiliation: Department of Obstetrics and Gynecology, Weill Medical College of Cornell University, New York, NY. Electronic address: amosgrune@gmail.com.
authors.forename: Amos
authors.initials: A
authors.lastname: Grünebaum
authors.affiliation: Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, TX.
authors.forename: Laurence B
authors.initials: LB
authors.lastname: McCullough
authors.affiliation: Department of Epidemiology, Mailman School of Public Health, Columbia University, New York, NY.
authors.forename: Katherine J
authors.initials: KJ
authors.lastname: Sapra
authors.affiliation: Department of Obstetrics and Gynecology, Weill Medical College of Cornell University, New York, NY; Alfred I. DuPont Hospital for Children, Thomas Jefferson University, Wilmington, DE.
authors.forename: Robert L
authors.initials: RL
authors.lastname: Brent
authors.affiliation: Division of Pediatrics and Child Health, University of Leeds, Leeds, England, UK.
authors.forename: Malcolm I
authors.initials: MI
authors.lastname: Levene
authors.affiliation: Center for Mother and Child, Philipps University, Marburg, and Clara Angela Foundation, Berlin, Germany.
authors.forename: Birgit
authors.initials: B
authors.lastname: Arabin
authors.affiliation: Department of Obstetrics and Gynecology, Weill Medical College of Cornell University, New York, NY.
authors.forename: Frank A
authors.initials: FA
authors.lastname: Chervenak
mesh_terms: D000328:Adult; D003696:Delivery Rooms; D036861:Delivery, Obstetric / Q000401:mortality*; D005260:Female; D006700:Home Childbirth / Q000401:mortality*; D006801:Humans; D007223:Infant; D007226:Infant Mortality; D007231:Infant, Newborn; D008880:Midwifery; D009721:Nurse Midwives; D010820:Physicians; D011247:Pregnancy; D047929:Term Birth; D014481:United States / Q000453:epidemiology
keywords: birth attendants; birth settings; home births; midwives; neonatal mortality; physicians