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Journal of Perinatal Medicine

Official Journal of the World Association of Perinatal Medicine

Editor-in-Chief: Dudenhausen, MD, FRCOG, Joachim W.

Ed. by Bancalari, Eduardo / Chappelle, Joseph / Chervenak, Frank A. / D'Addario , Vincenzo / Genc, Mehmet R. / Greenough, Anne / Grunebaum, Amos / Konje, Justin C. / Kurjak M.D., Asim / Romero, Roberto / Zalud, MD PhD, Ivica


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1619-3997
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Volume 45, Issue 3

Issues

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

Amos Grünebaum
  • Corresponding author
  • Department of Obstetrics and Gynecology, Weill Medical College of Cornell University, New York, NY, United States of America
  • Email
  • Other articles by this author:
  • De Gruyter OnlineGoogle Scholar
/ Laurence B. McCullough
  • Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, TX, United States of America
  • Other articles by this author:
  • De Gruyter OnlineGoogle Scholar
/ Birgit Arabin
  • Center for Mother and Child, Philipps University, Marburg, Germany
  • Clara Angela Foundation, Berlin, Germany
  • Other articles by this author:
  • De Gruyter OnlineGoogle Scholar
/ Joachim Dudenhausen / Brooke Orosz
  • Division of Mathematics and Physics, Essex County College, 303 University Avenue, Newark, NJ 07102, United States of America
  • Other articles by this author:
  • De Gruyter OnlineGoogle Scholar
/ Frank A. Chervenak
  • Department of Obstetrics and Gynecology, Weill Medical College of Cornell University, New York, NY, United States of America
  • Other articles by this author:
  • De Gruyter OnlineGoogle Scholar
Published Online: 2016-10-18 | DOI: https://doi.org/10.1515/jpm-2016-0200

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.

Keywords: Congenital anomaly; home birth; hypoxic ischemic encephalopathy; infection; midwife; neonatal mortality

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About the article

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


Received: 2016-06-10

Accepted: 2016-07-04

Published Online: 2016-10-18

Published in Print: 2017-04-01


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


Citation Information: Journal of Perinatal Medicine, Volume 45, Issue 3, Pages 349–357, ISSN (Online) 1619-3997, ISSN (Print) 0300-5577, DOI: https://doi.org/10.1515/jpm-2016-0200.

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