Planned home compared with planned hospital births: mode of delivery and Perinatal mortality rates, an observational study

BMC Pregnancy and Childbirth

Research Article

Eric A.P Steegers¹  Semiha Denktas¹  Jacoba van der Kooy¹  Erwin Birnie²  Gouke J. Bonsel³ 

[1] Department of Obstetrics and Gynecology, Division of Obstetrics & Prenatal Medicine, PO Box 2040, Room Hs-408, Erasmus MC, 3000, Rotterdam, CA, The Netherlands;Institute of Health Policy and Management, Erasmus University Rotterdam, PO Box 1738, 3000, Rotterdam, DR, The Netherlands;Academic Collaboration Mother and Child Care, Wilhelmina Child Hospital, University Medical Center Utrecht, Postbus 85090, 3508, Utrecht, AB, The Netherlands;University of Applied Sciences, Midwifery Academy Rotterdam (Verloskunde Academie Rotterdam), Dr. Molewaterplein 40, 3015, Rotterdam, GD, The Netherlands;Academic Collaboration Mother and Child Care, Wilhelmina Child Hospital, University Medical Center Utrecht, Postbus 85090, 3508, Utrecht, AB, The Netherlands;

关键词: Intervention;    Mortality;    Perinatal care;   

DOI  :  10.1186/s12884-017-1348-y

 received in 2015-10-20, accepted in 2017-05-25,  发布年份 2017

来源: Springer

【 摘 要 】

BackgroundTo compare the mode of delivery between planned home versus planned hospital births and to determine if differences in intervention rates could be interpreted as over- or undertreatment.MethodsIntervention and perinatal mortality rates were obtained for 679,952 low-risk women from the Dutch Perinatal Registry (2000–2007). Intervention was defined as operative vaginal delivery and/or caesarean section. Perinatal mortality was defined as the intrapartum and early neonatal mortality rate up to 7 days postpartum.Besides adjustment for maternal and care factors, we included for additional casemix adjustment: presence of congenital abnormality, small for gestational age, preterm birth, or low Apgar score. The techniques used were nested multiple stepwise logistic regression, and stratified analysis for separate risk groups. An intention-to-treat like analysis was performed.ResultsThe intervention rate was lower in planned home compared to planned hospital births (10.9% 95% CI 10.8–11.0 vs. 13.8% 95% CI 13.6–13.9). Intended place of birth had significant impact on the likelihood to intervene after adjustment (planned homebirth (OR 0.77 95% CI. 0.75–0.78)).The mortality rate was lower in planned home births (0.15% vs. 0.18%). After adjustment, the interaction term home- intervention was significant (OR1.51 95% CI 1.25–1.84). In risk groups, a higher perinatal mortality rate was observed in planned home births.ConclusionsThe potential presence of over- or under treatment as expressed by adjusted perinatal mortality differs per risk group. In planned home births especially multiparous women showed universally lower intervention rates. However, the benefit of substantially fewer interventions in the planned home group seems to be counterbalanced by substantially increased mortality if intervention occurs.

【 授权许可】

CC BY   
© The Author(s). 2017