Perinatal mortality and morbidity in a nationwide cohort of 529 688 low-risk planned
home and hospital births 15 April 2009
Objective
To compare perinatal mortality and severe perinatal
morbidity between planned home and planned hospital births,
among low-risk women who started their labour in primary care.
Design
A nationwide cohort study.
Setting
The entire Netherlands.
Population
A total of 529 688 low-risk women who were in
primary midwife-led care at the onset of labour. Of these, 321 307
(60.7%) intended to give birth at home, 163 261 (30.8%) planned
to give birth in hospital and for 45 120 (8.5%), the intended place
of birth was unknown.
neonatal death within 7 days and neonatal admission to an
intensive care unit.
Results
No significant differences were found between planned
home and planned hospital birth (adjusted relative risks and 95%
confidence intervals: intrapartum death 0.97 (0.69 to 1.37),
intrapartum death and neonatal death during the first 24 hours
1.02 (0.77 to 1.36), intrapartum death and neonatal death up to
7 days 1.00 (0.78 to 1.27), admission to neonatal intensive care
unit 1.00 (0.86 to 1.16).
Conclusions
This study shows that planning a home birth does
not increase the risks of perinatal mortality and severe perinatal
morbidity among low-risk women, provided the maternity care
system facilitates this choice through the availability of welltrained
midwives and through a good transportation and referral
system.
In conclusion, this study did not show increased risks of
perinatal mortality and severe perinatal morbidity, adjusted
for known confounding factors, among low-risk women
planning a home birth. Low-risk women should be encouraged
to plan their birth at the place of their preference,
provided the maternity care system is well equipped to
underpin women’s choice.
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