Neonatal mortality and prematurity: Comparison of 5,418 planned home births with full-term hospital births in the USA

We compared the neonatal mortality rate among 5,418 planned homebirths attended by Certified Professional Midwives in the year 2000 (CPM2000 study) to the U.S. National Institutes of Health (NIH) neonatal mortality rate for births in hospital to U.S. non-Hispanic white women of 37 weeks plus gestation. Prematurity rates were also examined for the two populations.

Adjustments were made to ensure that the comparisons were as close as possible to comparing like with like. This included removal from the CPM2000 study death rate of intrapartum mortality, 3 deaths involving lethal birth defects unlikely to have been carried to term in the hospital population, and 1 death and 286 births among African-American and Hispanic women. After making the necessary adjustments that were possible, the neonatal death rate in both datasets was just under 1 death per 1000. The premature birth rate for the NIH non-Hispanic white births in hospital was 11.3%, more than double the rate for the women who started care with Certified Professional Midwives.

Our conclusions remain unchanged from those in the original article -- the neonatal mortality rate for low risk women in North America using Certified Professional Midwives is similar to that for low risk women in hospital in the U.S., and the intervention rates are much lower. Additionally, higher prematurity is a serious concern for the care of women planning hospital births, because prematurity is associated with higher perinatal mortality and morbidity.