Outcomes of planned home births with certified professional midwives: large prospective study in North America

Kenneth C Johnson, Betty-Anne Daviss
Table 4

Combined intrapartum and neonatal mortality in studies of planned out of hospital births or low risk hospital births in North America (at least 500 births)

Type of studies and referencesLocation, periodNo of birthsCombined intrapartum and neonatal mortality (per 1000) *
Low risk out of hospital births attended by midwives:
Burnett et al11North Carolina, 1974-69343.0
Mehl et al12United States, 197711463.5
Schramm et al13Missouri, 1978-8417702.8
Janssen et al14Washington State, 1981-9069441.7
Sullivan and Beeman15Arizona, 198312432.4
Tyson16Canada, Toronto, 1983-810012.0
Hinds et al17Kentucky, 19855753.5
Durand18Farm, Tennessee, 1972-9217072.3
Rooks et al1984 birth centres across United States, 1985-711 8140.6
Anderson et al2090 home birth practices across United States, 1987-9111 0810.9
Pang et al21Washington State, 1989-9661332.0
Schlenzka22California, 1989-9033852.4
Murphy et al23United States, 1993-513502.5
Janssen et al24Canada, British Columbia, 1998-98622.3
Johnson and Daviss37United States and Canada, 200054181.7
Low risk births attended by physicians or obstetricians in hospitals:
Neutra et al25One academic hospital in Boston (lowest risk women), 1969-7512 0550.5-1.1
Amato26One community hospital, 1974-541443.
Adams2715 hospitals10 5211.7
Rooks et al28National natality survey, 198029352.5
Janssen et al14Washington, 1981-9023 5961.7
Leveno et al29One academic hospital in Dallas, 1982-514 6181.0
Eden et al30Twelve hospitals Illinois, 1982-581351.9
Pang et al21Washington State, 1989-9610 5930.7
Schlenzka22California 1989-90806 4021.9
Janssen et al24Canada, British Columbia, 1998-97331.4
  • Table is presented for general comparison only. Direct comparison of relative mortality between individual studies is ill advised. as many rates are unstable because of small numbers of deaths, study designs may differ (retrospective versus prospective, assessment and definition of low risk, etc.), the ability to capture and extract late neonatal mortality differs between studies, and significant differences may exist in populations studied with respect to factors such as socioeconomic status, distribution of parity, and risk screening criteria used. For example, see the study by Schlenzka. Although the crude mortality for low risk babies weighing over 2500 g intended at home was 2.4 per 1000 and intended in hospital was 1.9 per 1000, when standard methods were employed to adjust for differences in risk profiles of the two groups (indirect standardisation and logistic regression), both methods showed slightly lower risk for intended home births.

  • * Excludes lethal congenital anomalies.

  • † Neonatal mortality only, intrapartum mortality unreported.