title: Underlying causes of neonatal deaths in term singleton pregnancies: home births versus hospital births in the United States.
abstract: BACKGROUND
  The objective of this study was to evaluate the underlying causes of neonatal mortality (NNM) in midwife-attended home births and compare them to hospital births attended by a midwife or a physician in the United States (US).
  
  
  METHODS
  A retrospective cohort study of the Centers for Disease Control (CDC) linked birth/infant death data set (linked files) for 2008 through 2012 of singleton, term (≥37 weeks) births and normal newborn weights (≥2500 grams).
  
  
  RESULTS
  Midwife-attended home births had the highest rate of neonatal deaths [122/95,657 neonatal mortality (NNM) 12.75/10,000; relative risk (RR): 3.6, 95% confidence interval (CI) 3-4.4], followed by hospital physician births (8695/14,447,355 NNM 6.02/10,000; RR: 1.7 95% CI 1.6-1.9) and hospital midwife births (480/1,363,199 NNM 3.52/10,000 RR: 1). Among midwife-assisted home births, underlying causes attributed to labor and delivery caused 39.3% (48/122) of neonatal deaths (RR: 13.4; 95% CI 9-19.9) followed by 29.5% due to congenital anomalies (RR: 2.5; 95% CI 1.8-3.6), and 12.3% due to infections (RR: 4.5; 95% CI 2.5-8.1).
  
  
  CONCLUSIONS
  There are significantly increased risks of neonatal deaths among midwife-attended home births associated with three underlying causes: labor and delivery issues, infections, and fetal malformations. This analysis of the causes of neonatal death in planned home birth shows that it is consistently riskier for newborns to deliver at home than at the hospital. Physicians, midwives, and other health care providers have a professional responsibility to share information about the clinical benefits and risks of clinical management.
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.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: Center for Mother and Child, Philipps University, Marburg.
authors.forename: Birgit
authors.initials: B
authors.lastname: Arabin
authors.affiliation: Deptartment of Obstetrics, Charite University Medicine Berlin.
authors.forename: Joachim
authors.initials: J
authors.lastname: Dudenhausen
authors.affiliation: Division of Mathematics and Physics, Essex County College, 303 University Avenue, Newark, NJ 07102.
authors.forename: Brooke
authors.initials: B
authors.lastname: Orosz
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; D002423:Cause of Death; D015331:Cohort Studies; D036861:Delivery, Obstetric; D005260:Female; D006700:Home Childbirth / Q000009:adverse effects*; D006801:Humans; D007223:Infant; D007226:Infant Mortality; D007231:Infant, Newborn; D008297:Male; D008880:Midwifery; D061214:Patient Safety; D066087:Perinatal Death / Q000209:etiology* / Q000517:prevention & control; D011247:Pregnancy; D012189:Retrospective Studies; D012307:Risk Factors; D014481:United States / Q000453:epidemiology
keywords: Congenital anomaly; home birth; hypoxic ischemic encephalopathy; infection; midwife; neonatal mortality