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

ObjectiveTo compare rates of adverse perinatal outcomes between planned home births versus planned hospital births. DesignA nationwide cohort study. SettingThe Netherlands. PopulationLow-risk women in midwife-led care at the onset of labour. MethodsAnalysis of national registration data. Main outcome measuresIntrapartum and neonatal death, Apgar scores, and admission to a neonatal intensive care unit (NICU) within 28days of birth. ResultsOf the total of 814979 women, 466112 had a planned home birth and 276958 had a planned hospital birth. For 71909 women, their planned place of birth was unknown. The combined intrapartum and neonatal death rates up to 28days after birth, including cases with discrepancies in the registration of the moment of death, were: for nulliparous women, 1.02 for planned home births versus 1.09 parts per thousand for planned hospital births, adjusted odds ratio (aOR) 0.99, 95% confidence interval (95% CI) 0.79-1.24; and for parous women, 0.59 parts per thousand versus 0.58 parts per thousand, aOR 1.16, 95% CI 0.87-1.55. The rates of NICU admissions and low Apgar scores did not significantly differ among nulliparous women (NICU admissions up to 28days, 3.41 parts per thousand versus 3.61 parts per thousand, aOR 1.05, 95% CI 0.92-1.18). Among parous women the rates of Apgar scores below seven and NICU admissions were significantly lower among planned home births (NICU admissions up to 28days, 1.36 versus 1.95 parts per thousand, aOR 0.79, 95% CI 0.66-0.93). ConclusionsWe found no increased risk of adverse perinatal outcomes for planned home births among low-risk women. Our results may only apply to regions where home births are well integrated into the maternity care system.