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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



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).


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).


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).


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


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  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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