Planned Home Compared With Planned Hospital Births in The Netherlands

Kooy, Jacoba van der; Poeran, Jashvant; Graaf, Johanna P. de; Birnie, Erwin; Denktaş, Semiha; Steegers, Eric A.P.; Bonsel, Gouke J.

doi:10.1097/aog.0b013e3182319737

Cited by 82 publications

(38 citation statements)

References 28 publications

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“…For example, the Dutch home-birth system (in which home birth is common and adverse outcomes are rare) includes formal collaborative agreements between out-of-hospital and in-hospital providers, clear and mutually agreed-upon stratification of risk, and protocols for the transfer of care. 35,36 The process of devising evidence-based guidelines for U.S. home births is under way. 37 …”

Section: Discussionmentioning

confidence: 99%

Planned Out-of-Hospital Birth and Birth Outcomes

et al. 2015

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Background The frequency of planned out-of-hospital birth in the United States has increased in recent years. The value of studies assessing the perinatal risks of planned out-of-hospital birth versus hospital birth has been limited by cases in which transfer to a hospital is required and a birth that was initially planned as an out-of-hospital birth is misclassified as a hospital birth. Methods We performed a population-based, retrospective cohort study of all births that occurred in Oregon during 2012 and 2013 using data from newly revised Oregon birth certificates that allowed for the disaggregation of hospital births into the categories of planned in-hospital births and planned out-of-hospital births that took place in the hospital after a woman’s intrapartum transfer to the hospital. We assessed perinatal morbidity and mortality, maternal morbidity, and obstetrical procedures according to the planned birth setting (out of hospital vs. hospital). Results Planned out-of-hospital birth was associated with a higher rate of perinatal death than was planned in-hospital birth (3.9 vs. 1.8 deaths per 1000 deliveries, P = 0.003; odds ratio after adjustment for maternal characteristics and medical conditions, 2.43; 95% confidence interval [CI], 1.37 to 4.30; adjusted risk difference, 1.52 deaths per 1000 births; 95% CI, 0.51 to 2.54). The odds for neonatal seizure were higher and the odds for admission to a neonatal intensive care unit lower with planned out-of-hospital births than with planned in-hospital birth. Planned out-of-hospital birth was also strongly associated with unassisted vaginal delivery (93.8%, vs. 71.9% with planned in-hospital births; P<0.001) and with decreased odds for obstetrical procedures. Conclusions Perinatal mortality was higher with planned out-of-hospital birth than with planned in-hospital birth, but the absolute risk of death was low in both settings. (Funded by the Eunice Kennedy Shriver National Institute of Child Health and Human Development.)

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Section: Discussionmentioning

confidence: 99%

Planned Out-of-Hospital Birth and Birth Outcomes

et al. 2015

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“…These studies have found births at home and at birthing centers to have lower obstetrical resource use with associated decreases in maternal complications of interventions such as operative vaginal delivery, cesarean delivery, episiotomy, and epidural use. 4,18,20–25,29 Several studies have found that home births increase the risk of adverse neonatal outcomes, 4,11,19,24,28–30 although some have concluded there are no increased risks of adverse perinatal or maternal outcomes. 18,20,26,27 Studies of planned home births compared to planned hospital births involve a mixing of the level of care available at home and the characteristics of women who self-select for home births that make results difficult to interpret.…”

Section: Commentmentioning

confidence: 99%

Unexpected complications of low-risk pregnancies in the United States

Danilack

Nunes

Phipps

2015

American Journal of Obstetrics and Gynecology

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OBJECTIVE Determining appropriate sites of care for any type of medical issue assumes successful matching of patient risks to facility capabilities and resources. In obstetrics, predicting patients who will have a need for additional resources beyond routine obstetric and neonatal care is difficult. Women without prenatal risk factors and their newborns may experience unexpected complications during delivery or postpartum. In this study, we report the risk of unexpected maternal and newborn complications among pregnancies without identified prenatal risk factors. STUDY DESIGN We conducted a cross-sectional investigation utilizing US natality data to analyze 10 million birth certificate records from 2011 through 2013. We categorized pregnancies as low risk (no prenatal risk factors) or high risk (at least 1 prenatal risk factor) according to 19 demographic, medical, and pregnancy characteristics. We evaluated 21 individual unexpected or adverse intrapartum and postpartum outcomes in addition to a composite indicator of any adverse outcome. RESULTS Among 10,458,616 pregnancies, 38% were identified as low risk and 62% were identified as high risk for unexpected complications. At least 1 unexpected complication was indicated on the birth certificate for 46% of all pregnancies, 29% of low-risk pregnancies, and 57% of high-risk pregnancies. While the risk for unexpected or adverse outcomes was greatly reduced for the low-risk group compared to the high-risk group overall and for several of the individual outcomes, low-risk pregnancies had higher risks of vacuum delivery, forceps delivery, meconium staining, and chorioamnionitis compared to high-risk pregnancies. CONCLUSION Of births, 29% identified to be low risk had an unexpected complication that would require nonroutine obstetric or neonatal care. Additionally, for select outcomes, risks were higher in the low-risk group compared to the group with identified risk factors. This information is important for planning location of birth and evaluating birthing centers and hospitals for necessary resources to ensure quality care and patient safety.

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“…The use of planned rather than actual place of delivery is justified by the assumption that there is less endogeneity in planned than in actual birth place, since the actual birth place may deviate from the planned one due to changes in individual health and risk factors. The results, interpreted as an intention-totreat effect, are mixed, with some studies showing higher perinatal mortality risk among home births (e.g., Bastian et al, 1998;Pang et al, 2002;Kennare et al, 2010;Malloy, 2010;Birthplace in England Collaborative Group, 2011) and others finding no significant differences (e.g., Ackermann-Liebrich et al, 1996;Murphy and Fullerton, 1998;Janssen et al, 2002;Lindgren et al, 2008;de Jonge et al, 2009;van der Kooy et al, 2011).…”

Section: Previous Literaturementioning

confidence: 99%

Saving Lives at Birth: The Impact of Home Births on Infant Outcomes

2012

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Planned Home Compared With Planned Hospital Births in The Netherlands

Abstract: Home birth, under routine conditions, is generally not associated with increased intrapartum and early neonatal death, yet in subgroups, additional risk cannot be excluded.

Cited by 82 publications

References 28 publications

Planned Out-of-Hospital Birth and Birth Outcomes

Planned Out-of-Hospital Birth and Birth Outcomes

Unexpected complications of low-risk pregnancies in the United States

Saving Lives at Birth: The Impact of Home Births on Infant Outcomes

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