Objective
We examined neonatal mortality in relation to birth settings and birth attendants
in the United States from 2006 through 2009.
Study Design
Data from the Centers for Disease Control and Prevention–linked birth and infant death
dataset in the United States from 2006 through 2009 were used to assess early and
total neonatal mortality for singleton, vertex, and term births without congenital
malformations delivered by midwives and physicians in the hospital and midwives and
others out of the hospital. Deliveries by hospital midwives served as the reference.
Results
Midwife home births had a significantly higher total neonatal mortality risk than
deliveries by hospital midwives (1.26 per 1000 births; relative risk [RR], 3.87 vs
0.32 per 1000; P < .001). Midwife home births of 41 weeks or longer (1.84 per 1000; RR, 6.76 vs 0.27
per 1000; P < .001) and midwife home births of women with a first birth (2.19 per 1000; RR, 6.74
vs 0.33 per 1000; P < .001) had significantly higher risks of total neonatal mortality than deliveries
by hospital midwives. In midwife home births, neonatal mortality for first births
was twice that of subsequent births (2.19 vs 0.96 per 1000; P < .001). Similar results were observed for early neonatal mortality. The excess total
neonatal mortality for midwife home births compared with midwife hospital births was
9.32 per 10,000 births, and the excess early neonatal mortality was 7.89 per 10,000
births.
Conclusion
Our study shows a significantly increased total and early neonatal mortality for home
births and even higher risks for women of 41 weeks or longer and women having a first
birth. These significantly increased risks of neonatal mortality in home births must
be disclosed by all obstetric practitioners to all pregnant women who express an interest
in such births.
Key words
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Article Info
Publication History
Published online: March 24, 2014
Accepted:
March 19,
2014
Received in revised form:
February 12,
2014
Received:
January 19,
2014
Footnotes
The authors report no conflict of interest.
Cite this article as: Grünebaum A, McCullough LB, Sapra KJ, et al. Early and total neonatal mortality in relation to birth setting in the United States, 2006-2009. Am J Obstet Gynecol 2014;211:390.e1-7.
Identification
Copyright
© 2014 Elsevier Inc. Published by Elsevier Inc. All rights reserved.
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Access this article on ScienceDirectLinked Article
- Home birth study fails to identify credentials of midwives conducting home birthAmerican Journal of Obstetrics & GynecologyVol. 212Issue 2
- Early and total neonatal mortality in relation to birth setting in the United States, 2006-2009American Journal of Obstetrics & GynecologyVol. 212Issue 2
- PreviewThe recent study by Grünebaum et al1 demonstrated statistically significant, although incremental, increases in the unadjusted rates of total neonatal mortality in midwife-attended birth center births (0.59 per 1000; n = 39,523) compared with midwife-attended hospital births, particularly among nulliparas and gestations longer than 41 weeks.
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