title: Outcomes associated with planned place of birth among women with low-risk pregnancies.
abstract: BACKGROUND
  Previous studies have shown that planned home birth is associated with a decreased likelihood of intrapartum intervention with no difference in neonatal outcomes compared with planned hospital birth. The purpose of our study was to evaluate different birth settings by comparing neonatal mortality, morbidity and rates of birth interventions between planned home and planned hospital births in Ontario, Canada.
  
  
  METHODS
  We used a provincial database of all midwifery-booked pregnancies between 2006 and 2009 to compare women who planned home birth at the onset of labour to a matched cohort of women with low-risk pregnancies who had planned hospital births attended by midwives. We conducted subgroup analyses by parity. Our primary outcome was stillbirth, neonatal death (< 28 d) or serious morbidity (Apgar score < 4 at 5 min or resuscitation with positive pressure ventilation and cardiac compressions).
  
  
  RESULTS
  We compared 11 493 planned home births and 11 493 planned hospital births. The risk of our primary outcome did not differ significantly by planned place of birth (relative risk [RR] 1.03, 95% confidence interval [CI] 0.68-1.55). These findings held true for both nulliparous (RR 1.04, 95% CI 0.62-1.73) and multiparous women (RR 1.00, 95% CI 0.49-2.05). All intrapartum interventions were lower among planned home births.
  
  
  CONCLUSIONS
  Compared with planned hospital birth, planned home birth attended by midwives in a jurisdiction where home birth is well-integrated into the health care system was not associated with a difference in serious adverse neonatal outcomes but was associated with fewer intrapartum interventions.
authors.affiliation: Department of Obstetrics and Gynecology (Hutton, Ahmed), The Michael G. DeGroote School of Medicine; Midwifery Education Program (Hutton, Cappelletti, Reitsma, Simioni, Horne, McGregor), Faculty of Health Sciences, McMaster University, Hamilton, Ont. huttone@mcmaster.ca.
authors.forename: Eileen K
authors.initials: EK
authors.lastname: Hutton
authors.affiliation: Department of Obstetrics and Gynecology (Hutton, Ahmed), The Michael G. DeGroote School of Medicine; Midwifery Education Program (Hutton, Cappelletti, Reitsma, Simioni, Horne, McGregor), Faculty of Health Sciences, McMaster University, Hamilton, Ont.
authors.forename: Adriana
authors.initials: A
authors.lastname: Cappelletti
authors.affiliation: Department of Obstetrics and Gynecology (Hutton, Ahmed), The Michael G. DeGroote School of Medicine; Midwifery Education Program (Hutton, Cappelletti, Reitsma, Simioni, Horne, McGregor), Faculty of Health Sciences, McMaster University, Hamilton, Ont.
authors.forename: Angela H
authors.initials: AH
authors.lastname: Reitsma
authors.affiliation: Department of Obstetrics and Gynecology (Hutton, Ahmed), The Michael G. DeGroote School of Medicine; Midwifery Education Program (Hutton, Cappelletti, Reitsma, Simioni, Horne, McGregor), Faculty of Health Sciences, McMaster University, Hamilton, Ont.
authors.forename: Julia
authors.initials: J
authors.lastname: Simioni
authors.affiliation: Department of Obstetrics and Gynecology (Hutton, Ahmed), The Michael G. DeGroote School of Medicine; Midwifery Education Program (Hutton, Cappelletti, Reitsma, Simioni, Horne, McGregor), Faculty of Health Sciences, McMaster University, Hamilton, Ont.
authors.forename: Jordyn
authors.initials: J
authors.lastname: Horne
authors.affiliation: Department of Obstetrics and Gynecology (Hutton, Ahmed), The Michael G. DeGroote School of Medicine; Midwifery Education Program (Hutton, Cappelletti, Reitsma, Simioni, Horne, McGregor), Faculty of Health Sciences, McMaster University, Hamilton, Ont.
authors.forename: Caroline
authors.initials: C
authors.lastname: McGregor
authors.affiliation: Department of Obstetrics and Gynecology (Hutton, Ahmed), The Michael G. DeGroote School of Medicine; Midwifery Education Program (Hutton, Cappelletti, Reitsma, Simioni, Horne, McGregor), Faculty of Health Sciences, McMaster University, Hamilton, Ont.
authors.forename: Rashid J
authors.initials: RJ
authors.lastname: Ahmed
mesh_terms: D000328:Adult; D001034:Apgar Score; D016887:Cardiopulmonary Resuscitation / Q000706:statistics & numerical data*; D016022:Case-Control Studies; D015331:Cohort Studies; D036861:Delivery, Obstetric; D005260:Female; D006700:Home Childbirth; D006761:Hospitals; D006801:Humans; D007231:Infant, Newborn; D033182:Intention; D008880:Midwifery; D009864:Ontario; D010298:Parity; D066087:Perinatal Death; D011247:Pregnancy; D012189:Retrospective Studies; D050497:Stillbirth / Q000453:epidemiology*; D055815:Young Adult