176244 Neonatal mortality and prematurity: Comparison of 5,418 planned home births with full-term hospital births in the USA

Monday, October 27, 2008: 5:20 PM

Betty-Anne Daviss, MSc, RM , Midwifery Collective of Ottawa, Ottawa, ON, Canada
Kenneth C. Johnson, PhD , Department of Epidemiology and Community Medicine, University of Ottawa, Ottawa, ON, Canada
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.

Learning Objectives:
1) Recognize that when evaluating neonatal mortality between data sets, adjustments may need to be made to make suitable comparisons of risk. 2) Describe the differences in prematurity rates between the population served by Certified Professional Midwives with the US hospital birth population. 3) Identify three factors that must be considered when comparing home birth data with birth certificate data.

Presenting author's disclosure statement:

Qualified on the content I am responsible for because: I am a PHD epidemiologist and have published several papers inthe area and presented 6 time before at APHA.
Any relevant financial relationships? No

I agree to comply with the American Public Health Association Conflict of Interest and Commercial Support Guidelines, and to disclose to the participants any off-label or experimental uses of a commercial product or service discussed in my presentation.