title: Perinatal mortality and morbidity up to 28 days after birth among 743 070 low-risk planned home and hospital births: a cohort study based on three merged national perinatal databases.
abstract: OBJECTIVE
  To compare rates of adverse perinatal outcomes between planned home births versus planned hospital births.
  
  
  METHODS
  A nationwide cohort study.
  
  
  METHODS
  The Netherlands.
  
  
  METHODS
  Low-risk women in midwife-led care at the onset of labour.
  
  
  METHODS
  Analysis of national registration data.
  
  
  METHODS
  Intrapartum and neonatal death, Apgar scores, and admission to a neonatal intensive care unit (NICU) within 28 days of birth.
  
  
  RESULTS
  Of the total of 814 979 women, 466 112 had a planned home birth and 276 958 had a planned hospital birth. For 71 909 women, their planned place of birth was unknown. The combined intrapartum and neonatal death rates up to 28 days after birth, including cases with discrepancies in the registration of the moment of death, were: for nulliparous women, 1.02‰ for planned home births versus 1.09‰ for planned hospital births, adjusted odds ratio (aOR) 0.99, 95% confidence interval (95% CI) 0.79-1.24; and for parous women, 0.59‰ versus 0.58‰, aOR 1.16, 95% CI 0.87-1.55. The rates of NICU admissions and low Apgar scores did not significantly differ among nulliparous women (NICU admissions up to 28 days, 3.41‰ versus 3.61‰, aOR 1.05, 95% CI 0.92-1.18). Among parous women the rates of Apgar scores below seven and NICU admissions were significantly lower among planned home births (NICU admissions up to 28 days, 1.36 versus 1.95‰, aOR 0.79, 95% CI 0.66-0.93).
  
  
  CONCLUSIONS
  We found no increased risk of adverse perinatal outcomes for planned home births among low-risk women. Our results may only apply to regions where home births are well integrated into the maternity care system.
authors.affiliation: Department of Midwifery Science, AVAG and the EMGO Institute of Health and Care Research, VU University Medical Centre, Amsterdam, the Netherlands.
authors.forename: A
authors.initials: A
authors.lastname: de Jonge
authors.forename: C C
authors.initials: CC
authors.lastname: Geerts
authors.forename: B Y
authors.initials: BY
authors.lastname: van der Goes
authors.forename: B W
authors.initials: BW
authors.lastname: Mol
authors.forename: S E
authors.initials: SE
authors.lastname: Buitendijk
authors.forename: J G
authors.initials: JG
authors.lastname: Nijhuis
mesh_terms: D001034:Apgar Score; D016208:Databases, Factual; D036861:Delivery, Obstetric / Q000009:adverse effects / Q000401:mortality* / Q000706:statistics & numerical data; D005260:Female; D006700:Home Childbirth / Q000009:adverse effects / Q000401:mortality* / Q000706:statistics & numerical data; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal; D009017:Morbidity; D009426:Netherlands / Q000453:epidemiology; D016017:Odds Ratio; D010343:Patient Admission / Q000706:statistics & numerical data; D010347:Patient Care Planning; D018743:Perinatal Care; D054238:Perinatal Mortality; D011247:Pregnancy; D011256:Pregnancy Outcome; D011446:Prospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index
keywords: Homebirth; midwifery; perinatal mortality