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57: Term neonatal deaths resulting from home births: an increasing trend

      Objective

      Home births have increased over the last years. The objective of our study was to examine excess term neonatal mortality rates by birth location (hospital, birthing centers, and home births) and by providers (midwives, doctors, and “others” for home births) and to document the number of excess neonatal deaths resulting from the increase in home births.

      Study Design

      A retrospective cohort study using the CDC linked birth/infant death data set for term (>=37 weeks), >=2500 grams, singleton live births, excluding congenital anomalies from 2007 to 2009. Deliveries were categorized by setting: hospitals, birthing centers, and home as well as providers (midwives, doctors, and “others” for home births). Neonatal mortality (NNM) was defined as neonatal deaths up to 28 days after delivery. Hospital midwives served as reference.

      Results

      There were a total of 10,453,778 term deliveries between 2007 and 2009 which met study criteria: 9,526,450 (91.13%) were by hospital physicians, 826,543 (7.91%) by hospital midwives, 30,415 (0.29%) by midwives in freestanding birthing centers, 48,202 (0.46%) by midwives at home, and 22,168 (0.21%) by others at home. NNM for those delivered at home by others and by midwives, and those delivered in a freestanding birthing center was significantly higher than those delivered by midwives in the hospital: hospital midwives: 3.1/10,000 (RR:1); home others: 18.2/10,000 (RR: 5.87; 95%CI: 4.21-8.19), home midwives: 13.2/10,000; (RR: 4.32 95%CI: 3.29-5.68), freestanding birthing center: 6.3/10,000;(RR: 2.03; 95%CI: 1.28-3.24). The excess NNM for home births by midwives was 10.2/10,000 births (95% CI 6.9-13.2), and 15.0/10,000 births (95% CI 9.4-20.6) for home births by “others”.

      Conclusion

      Our study documents the number of excess term neonatal deaths resulting from home births.
      If home births continue to grow at a 6% per year rate, then excess yearly neonatal deaths from home births will increase by about 1/3 from about 31 in 2010 to about 42 in 2015.
      Figure thumbnail fx1
      Predicted excess neonatal deaths from home births by year
      Tabled 1Total and excess neonatal mortality by setting and attendant
      Figure thumbnail fx2