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Licensed Unlicensed Requires Authentication Published by De Gruyter October 18, 2016

Underlying causes of neonatal deaths in term singleton pregnancies: home births versus hospital births in the United States

Amos Grünebaum, Laurence B. McCullough, Birgit Arabin, Joachim Dudenhausen, Brooke Orosz and Frank A. Chervenak

Abstract

Introduction:

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).

Comment:

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.


Corresponding author: Amos Grünebaum, MD, Department of Obstetrics and Gynecology, Weill Medical College of Cornell University, New York, NY, USA

References

[1] Grünebaum A, McCullough LB, Sapra KJ, Brent RL4, Levene MI5, Arabin B, 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.e1–7.10.1016/j.ajog.2014.03.047Search in Google Scholar

[2] Cheng YW, Snowden JM, King TL, Caughey AB. Selected perinatal outcomes associated with planned home births in the United States. Am J Obstet Gynecol. 2013;209:325.e1–8.10.1016/j.ajog.2013.06.022Search in Google Scholar

[3] Wax JR, Lucas FL, Lamont M, Cartin A, Blackstone, J. Maternal and newborn outcomes in planned home birth vs planned hospital births: a metaanalysis. Am J Obstet Gynecol. 2010;203:243.e1–8.10.1016/j.ajog.2010.05.028Search in Google Scholar

[4] Grünebaum A, McCullough LB, Sapra KJ, Brent RL, Levene MI, Arabin B, et al. Apgar score of zero at five minutes and neonatal seizures or serious neurologic dysfunction in relation to birth setting. Am J Obstet Gynecol. 2013;209:323. e1–6.10.1016/j.ajog.2013.06.025Search in Google Scholar

[5] National Center for Health Statistics. Vital Statistics Data Available Online: Birth Data Files. Available at: http://www.cdc.gov/nchs/data_access/VitalStatsOnline.htm (last accessed April 15, 2015).Search in Google Scholar

[6] http://www.cdc.gov/reproductivehealth/maternalinfanthealth/infantmortality.htm (last accessed 5/2/2015).Search in Google Scholar

[7] Matthews TJ, MacDorman MF. Infant mortality statistics from the 2010 period linked birth/infant death data set. Natl Vital Stat Rep. 2013;62:1–26.Search in Google Scholar

[8] Tolson GC, Barnes JM, Gay GA, Kowaleski JL. The 1989 revision of the U.S. standard certificates and reports. National Center for Health Statistics. Vital Health Stat 4. 1991:1–34. http://www.cdc.gov/nchs/data/dvs/std-dcrt.pdf.Search in Google Scholar

[9] Murphy SL, Xu J, Kochanek KD. Deaths: final data for 2010. National vital statistics reports; vol 61 no 4. Hyattsville, MD: National Center for Health Statistics, 2013.Search in Google Scholar

[10] Documentation for the mortality public use data set, 1999 Last accessed April 5, 2015: http://www.cdc.gov/nchs/data/dvs/mort99doc.pdf.Search in Google Scholar

[11] U.S. Standard Certificate of Death: http://www.cdc.gov/nchs/data/dvs/death11-03final-acc.pdf accessed May 5, 2015.Search in Google Scholar

[12] Dean AG, Sullivan KM, Soe MM. OpenEpi: open source epidemiologic statistics for public health, version 2.3.1. Updated June 23, 2011. Available at: www.OpenEpi.com. Last accessed May 1, 2015.Search in Google Scholar

[13] World Health Organization. International statistical classification of diseases and related health problems, tenth revision. Geneva. 1992.Search in Google Scholar

[14] Cheyney M, Bovbjerg M, Everson C, Gordon W, Hannibal D, Vedam S. Outcomes of care for 16,924 planned home births in the United States: the midwives alliance of North America Statistics Project, 2004 to 2009. J Midwifery Womens Health. 2014;59:11–27.10.1111/jmwh.12172Search in Google Scholar

[15] de Jonge A, Geerts CC, van der Goes BY, Mol BW, Buitendijk SE, Nijhuis JG. Perinatal mortality and morbidity up to 28 days after birth among 743 070 low-risk planned home and hospital births: a cohort study based on three merged national perinatal databases. Br J Obstet Gynaecol. 2015;122:720–8.10.1111/1471-0528.13084Search in Google Scholar

[16] Anderson RE, Murphy PA. Outcomes of 11,788 planned home births attended by certified nurse-midwives. A retrospective descriptive study. J Nurse Midwifery. 1995;40:483–92.10.1016/0091-2182(95)00051-8Search in Google Scholar

[17] Murphy PA, Fullerton J. Outcomes of intended home births in nurse-midwifery practice: a prospective descriptive study. Obstet Gynecol. 1998;92:461–70.10.1097/00006250-199809000-00028Search in Google Scholar

[18] Johnson KC, Daviss BA. Outcomes of planned home births with certified professional midwives: large prospective study in North America. Br Med J. 2005;330:1416.10.1136/bmj.330.7505.1416Search in Google Scholar PubMed PubMed Central

[19] Committee opinion no. 669: planned home birth. Obstet Gynecol. 2016;128:e26–31.10.1097/AOG.0000000000001586Search in Google Scholar PubMed

[20] American College of Obstetricians and Gynecologists Committee on Patient Safety and Quality Improvement. Committee opinion no. 590: preparing for clinical emergencies in obstetrics and gynecology. Obstet Gynecol. 2014;123:722–5.10.1097/01.AOG.0000444442.04111.c6Search in Google Scholar

[21] Joseph KS, Pressey T, Lyons J, Bartholomew S, Liu S, Muraca G, et al. Once more unto the breech: planned vaginal delivery compared with planned cesarean delivery. Obstet Gynecol. 2015;125:1162–7.10.1097/AOG.0000000000000824Search in Google Scholar

[22] Grünebaum A, McCullough LB, Brent RL, Arabin B, Levene MI, Chervenak FA. Perinatal risks of planned home births in the United States. Am J Obstet Gynecol. 2015;212:350.e1–6.10.1016/j.ajog.2014.10.021Search in Google Scholar

[23] ACOG Committee Opinion No. 340. Mode of term singleton breech delivery. (ACOG Committee on Obstetric Practice) Obstet Gynecol. 2006;108:235–7.Search in Google Scholar

[24] Hannah ME, Hannah WJ, Hewson SA, Hodnett ED, Saigal S, Willan AR. Planned cesarean section versus planned vaginal birth for breech presentation at term: a randomized multicenter trial; term breech trial collaborative group. Lancet. 2000;356:1375–83.10.1016/S0140-6736(00)02840-3Search in Google Scholar

[25] Azria E, Le Meaux JP, Khoshnood B, Alexander S, Subtil D, Goffinet F; PREMODA Study Group. Factors associated with adverse perinatal outcomes for term breech fetuses with planned vaginal delivery. Am J Obstet Gynecol. 2012;207:285.e1–9.10.1016/j.ajog.2012.08.027Search in Google Scholar PubMed

[26] Schrag SJ, Zywicki S, Farley MM, Reingold AL, Harrison LH, Lefkowitz LB, et al. Group B streptococcal disease in the era of intrapartum antibiotic prophylaxis. N Engl J Med. 2000;342: 15–20.10.1056/NEJM200001063420103Search in Google Scholar PubMed

[27] Verani JR, McGee L, Schrag SJ; Prevention of perinatal group B streptococcal disease – revised guidelines from CDC, 2010. MMWR Recomm Rep. 2010;59:1–36.Search in Google Scholar

[28] Johnson CT, Farzin A, Burd I. Current management and long-term outcomes following chorioamnionitis. Obstet Gynecol Clin North Am. 2014;41:649–69.10.1016/j.ogc.2014.08.007Search in Google Scholar PubMed PubMed Central

[29] Dare MR, Middleton P, Crowther CA, Flenady VJ, Varatharaju B. Planned early birth versus expectant management (waiting) for prelabour rupture of membranes at term (37 weeks or more). Cochrane Database Syst Rev. 2006;1:CD005302.10.1002/14651858.CD005302.pub2Search in Google Scholar PubMed

[30] López-Zeno JA, Peaceman AM, Adashek JA, Socol ML, A controlled trial of a program for the active management of labor. N Engl J Med. 1992;326:450–4.10.1056/NEJM199202133260705Search in Google Scholar PubMed

[31] ACOG Practice Bulletin No. 139: Premature rupture of membranes. American College of Obstetricians and Gynecologists. Obstet Gynecol. 2013;122:918–30.10.1097/01.AOG.0000435415.21944.8fSearch in Google Scholar PubMed

[32] Johnson BA, Ades A. Delivery room and early postnatal management of neonates who have prenatally diagnosed congenital heart disease. Clin Perinatol. 2005;32:921–46, ix.10.1016/j.clp.2005.09.014Search in Google Scholar PubMed

[33] Werlein A, Goebert P, Maier RF. Planning delivery in cases of congenital malformations from the neonatologist’s point of view]. Z Geburtshilfe Neonatol. 2014;218:27–33.Search in Google Scholar

[34] Spain JE, Tuuli MG, Macones GA, Roehl KA, Odibo AO, Cahill AG. Risk factors for serious morbidity in term nonanomalous neonates. Am J Obstet Gynecol. 2015;212:799.e1–7.10.1016/j.ajog.2015.01.028Search in Google Scholar PubMed

[35] Birthplace in England Collaborative Group, Brocklehurst P, Hardy P, Hollowell J, Linsell L, Macfarlane A, et al. Perinatal and maternal outcomes by planned place of birth for healthy women with low risk pregnancies: the birthplace in England national prospective cohort study. Br Med J. 2011;343:d7400.10.1136/bmj.d7400Search in Google Scholar PubMed PubMed Central

[36] Buekens P, Keirse MJ. In the literature: home birth: safe enough, but not for the first baby. Birth. 2012;39:165–7.10.1111/j.1523-536X.2012.00536.xSearch in Google Scholar PubMed

[37] American Academy of Pediatrics: Policy Statement Planned Home birth. Pediatrics. 2013:131:1016–20.10.1542/peds.2013-0575Search in Google Scholar

[38] Commissie Verloskunde van het CVZ. Verloskundig Vademecum 2003. Diemen, the Netherlands: College voor Zorgverzekeringen, 2003.Search in Google Scholar

[39] Janssen PA, Saxell L, Page LA, Klein MC, Liston RM, Lee SK. Outcomes of planned home birth with registered midwife versus planned hospital birth with midwife or physician. [published erratum appears in] Can Med Assoc J. 2009;181: 377–83.10.1503/cmaj.081869Search in Google Scholar PubMed PubMed Central

[40] Kennare RM, Keirse MJ, Tucker GR, Chan AC. Planned home and hospital births in South Australia, 1991–2006: differences in outcomes. Med J Aust. 2010;192:76–80.10.5694/j.1326-5377.2010.tb03422.xSearch in Google Scholar PubMed

[41] Macdorman MF, Declercq E, Mathews TJ, Stotland N. Trends and characteristics of home vaginal birth after cesarean delivery in the United States and selected States. Obstet Gynecol. 2012;119:737–44.10.1097/AOG.0b013e31824bb050Search in Google Scholar PubMed

[42] Cox KJ, Bovbjerg ML, Cheyney M, Leeman LM. Planned home VBAC in the United States, 2004–2009: outcomes, maternity care practices, and implications for shared decision making.Birth. 2015;42:299–308.10.1111/birt.12188Search in Google Scholar PubMed

[43] Cook E, Avery M, Frisvold M. Formulating evidence-based guidelines for certified nurse-midwives and certified midwives attending home births. J Midwifery Womens Health. 2014;59:153–9.10.1111/jmwh.12142Search in Google Scholar PubMed

[44] Grunebaum A, Chervenak F, Skupski D. Effect of a comprehensive obstetric patient safety program on compensation payments and sentinel events. Am J Obstet Gynecol. 2011;204:97–105.10.1016/j.ajog.2010.11.009Search in Google Scholar PubMed

[45] Weiner E, Bar J, Fainstein N, Ben-Haroush A, Sadan O, Golan A, et al. The effect of a program to shorten the decision-to-delivery interval for emergent cesarean section on maternal and neonatal outcome. Am J Obstet Gynecol. 2014;210:224.e1–6.10.1016/j.ajog.2014.01.007Search in Google Scholar PubMed

[46] Kirschbaum KA, Rask JP, Brennan M, Phelan S, Fortner SA. Improved climate, culture, and communication through multidisciplinary training and instruction. Am J Obstet Gynecol. 2012;207:200.e1–7.10.1016/j.ajog.2012.06.036Search in Google Scholar PubMed

[47] Grunebaum A, Dudenhausen J, Chervenak FA, Skupski D. Reduction of cesarean delivery rates after implementation of a comprehensive patient safety program. J Perinat Med. 2013;41:51–5.10.1515/jpm-2012-0181Search in Google Scholar PubMed

[48] Matthews TJ, MacDorman MF. Infant mortality statistics from the 2008 period linked birth/infant death data set. Natl Vital Stat Rep. 2012;60:1–27.Search in Google Scholar

[49] Matthews TJ, MacDorman MF. Infant Mortality statistics from the 2009 period linked birth/infant death data set. Natl Vital Stat Rep. 2013;61:1–27.Search in Google Scholar

[50] DiGiuseppe DL, Aron DC, Ranbom L, Harper DL, Rosenthal GE. Reliability of birth certificate data: a multi-hospital comparison to medical records information. Mat Child Health J. 2002;6:169–79.10.1023/A:1019726112597Search in Google Scholar

[51] Zollinger TW, Przybylski MJ, Gamache RE. Reliability of Indiana birth certificate data compared to medical records. Ann Epidemiol. 2006;16:1–10.10.1016/j.annepidem.2005.03.005Search in Google Scholar PubMed

[52] Northam S, Knapp TR. The reliability and validity of birth certificates. J Obstet Gynecol Neonatal Nurs. 2006;35:3–12.10.1111/j.1552-6909.2006.00016.xSearch in Google Scholar PubMed

[53] Brody BA, McCullough LB, Sharp RR. Consensus and controversy in clinical research ethics. J Am Med Assoc. 2005;294:1411–4.10.1001/jama.294.11.1411Search in Google Scholar PubMed

[54] Evers AC, Brouwers HA, Hukkelhoven CW, Nikkels PG, Boon J, van Egmond-Linden A, et al. Perinatal mortality and severe morbidity in low and high risk term pregnancies in the Netherlands: prospective cohort study. Br Med J. 2010;341:c5639.10.1136/bmj.c5639Search in Google Scholar PubMed

[55] Rowe RE, Townend J, Brocklehurst P, Knight M, Macfarlane A, McCourt C, et al. Duration and urgency of transfer in births planned at home and in freestanding midwifery units in England: secondary analysis of the birthplace national prospective cohort study. BMC Pregnancy Childbirth. 2013;13:224.10.1186/1471-2393-13-224Search in Google Scholar PubMed PubMed Central

[56] Bix E, Kumle M, Kjærgaard H, Øian P, Lindren HE. Transfer to hospital in planned home births: a systematic review. BMC Pregnancy Childbirth. 2014;14:179.10.1186/1471-2393-14-179Search in Google Scholar PubMed PubMed Central

[57] Chervenak FA, McCullough LB, Brent RL, Levene MI, Arabin B. Planned home birth: the professional responsibility response. Am J Obstet Gynecol. 2013;208:31–8.10.1016/j.ajog.2012.10.002Search in Google Scholar PubMed

[58] Chervenak FA, McCullough LB, Grünebaum A, Arabin B, Levene MI, Brent RL. Planned home birth in the United States and professionalism: a critical assessment. J Clin Ethics. 2013;24:184–91.Search in Google Scholar

  1. The authors stated that there are no conflicts of interest regarding the publication of this article.

Received: 2016-6-10
Accepted: 2016-7-4
Published Online: 2016-10-18
Published in Print: 2017-4-1

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