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65: Neonatal outcomes associated with intended place of birth: birth centers and home birth compared to hospitals

      Objective

      To examine whether neonatal outcomes differ in women who intended home births, and births that occurred at birthing centers compared to hospitals.

      Study Design

      This was a retrospective cohort study of singleton live births that occurred in 2008 in the U.S. that had specified birthing facility information. Deliveries were categorized by location of occurrence: hospitals, birthing centers, or intended home births. Neonatal outcomes were compared using chi-square test and potential confounders adjusted for by multivariable logistic regression.

      Results

      There were 2,296,953 singleton, live, term births meeting study criteria; of these, 10,726 (0.47%) delivered at birthing centers and 12,433 (0.54%) had intended home births. While the risk of cesarean delivery was much lower for women who delivered/or intend to deliver outside of hospitals (0.02-4% vs. 24%, p<0.001), the odds of 5-minute Apgar score<7 and neonatal seizure was significantly higher for intended home births compared to hospital birth (see Table) .
      Tabled 1
      Table thumbnail grt2

      Conclusion

      The risk of cesarean delivery is significantly lower for women who had or intend to have births outside of hospitals; however, the risk of lower 5-minute Apgar score and neonatal seizure was higher for intended home births. This trade-off between maternal benefit and neonatal risk of deliveries outside of hospital should be weighed in the decision regarding birthing facility preferences.