Jump to ContentJump to Main Navigation
Show Summary Details
More options …

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

IMPACT FACTOR 2017: 1.558
5-year IMPACT FACTOR: 1.653

CiteScore 2017: 1.26

SCImago Journal Rank (SJR) 2017: 0.594
Source Normalized Impact per Paper (SNIP) 2017: 0.684

See all formats and pricing
More options …
Volume 45, Issue 3


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



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.

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


  • [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.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.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.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.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).

  • [6]

    http://www.cdc.gov/reproductivehealth/maternalinfanthealth/infantmortality.htm (last accessed 5/2/2015).

  • [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.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.

  • [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.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.

  • [11]

    U.S. Standard Certificate of Death: http://www.cdc.gov/nchs/data/dvs/death11-03final-acc.pdf accessed May 5, 2015.

  • [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.

  • [13]

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

  • [19]

    Committee opinion no. 669: planned home birth. Obstet Gynecol. 2016;128:e26–31.Google Scholar

  • [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.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.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.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.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.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.Google Scholar

  • [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.Google Scholar

  • [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.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.Google Scholar

  • [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.Google Scholar

  • [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.Google Scholar

  • [31]

    ACOG Practice Bulletin No. 139: Premature rupture of membranes. American College of Obstetricians and Gynecologists. Obstet Gynecol. 2013;122:918–30.Google Scholar

  • [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.Google Scholar

  • [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.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.Google Scholar

  • [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.Google Scholar

  • [36]

    Buekens P, Keirse MJ. In the literature: home birth: safe enough, but not for the first baby. Birth. 2012;39:165–7.Google Scholar

  • [37]

    American Academy of Pediatrics: Policy Statement Planned Home birth. Pediatrics. 2013:131:1016–20.Google Scholar

  • [38]

    Commissie Verloskunde van het CVZ. Verloskundig Vademecum 2003. Diemen, the Netherlands: College voor Zorgverzekeringen, 2003.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.Google Scholar

  • [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.Google Scholar

  • [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.Google Scholar

  • [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.Google Scholar

  • [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.Google Scholar

  • [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.Google Scholar

  • [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.Google Scholar

  • [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.Google Scholar

  • [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.Google Scholar

  • [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.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.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.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.Google Scholar

  • [52]

    Northam S, Knapp TR. The reliability and validity of birth certificates. J Obstet Gynecol Neonatal Nurs. 2006;35:3–12.Google Scholar

  • [53]

    Brody BA, McCullough LB, Sharp RR. Consensus and controversy in clinical research ethics. J Am Med Assoc. 2005;294:1411–4.Google Scholar

  • [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.Google Scholar

  • [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.Google Scholar

  • [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.Google Scholar

  • [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.Google Scholar

  • [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.Google Scholar

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.

Export Citation

©2017 Walter de Gruyter GmbH, Berlin/Boston.Get Permission

Comments (0)

Please log in or register to comment.
Log in