TABLE 5.
Comparison of Fetal/Neonatal Health Outcomes for Women With Low-Risk Pregnancies Planning a Home Birth at the Onset of Labor Versus Low-Risk Individuals Planning a Birth Center Birth
| Variable name | Total sample n (%) | Planned home births n (%) | Planned birth center births n (%) | aOR (95% CI)* |
|---|---|---|---|---|
| Outcome | ||||
| Total sample | ||||
| PDR | 50,043 | 1704 (3.4) | 48,339 (96.6) | — |
| MANAStats | 62,984 | 42,778 (67.9) | 20,206 (32.1) | — |
| Neonatal transfer—urgent† ‡ | ||||
| PDR | 375 (0.9) | 9 (0.7) | 366 (0.9) | 0.84 (0.43–1.64) |
| MANAStats | 624 (1.0) | 382 (0.9) | 242 (1.2) | 0.81 (0.69–0.96) |
| Neonatal hospitalization, through 6 wk postpartum‡ | ||||
| PDR | 1093 (2.7) | 30 (2.0) | 1063 (2.8) | 0.77 (0.53–1.11) |
| MANAStats | 2203 (3.5) | 1420 (3.3) | 783 (4.0) | 0.90 (0.82–0.98) |
| NICU admission‡ | ||||
| PDR | 594 (1.2) | 10 (0.6) | 584 (1.2) | 0.54 (0.28–1.00) |
| MANAStats | 1213 (1.9) | 804 (1.9) | 409 (2.0) | 0.97 (0.86–1.10) |
| Intrapartum or neonatal death§ | ||||
| MANAStats | 90 (1.43/1000) | 60 (1.40/1000) | 30 (1.48/1000) | 1.07 (0.68–1.67) |
| Intrapartum death | ||||
| MANAStats | 48 (0.76/1000) | 34 (0.79/1000) | 14 (0.69/1000) | 1.26 (0.67–2.40) |
| Neonatal death∥ | ||||
| MANAStats | 42 (0.67/1000) | 26 (0.61/1000) | 16 (0.79/1000) | 0.89 (0.47–1.69) |
Data are from 2 large community birth data registries in the United States: the Perinatal Data Registry (2012–2019) and MANAStats (20121–2018). Results are from unconditional logistic regression models. All ORs are presented as planned homes compared with planned birth centers; an odds ratio <1 means that the outcome is less common among planned home births, and an odds ratio >1 means the outcome is more common among planned home births. Multiparous, history of both cesarean and vaginal birth.
Adjusted for provider credential (certified professional midwife, certified nurse midwife/certified midwife, other), maternal demographics (public insurance, maternal education, maternal race/ethnicity, married/partnered), and pregnancy-related risk factors (advanced maternal age, pre-gravid body mass index, parity).
Models are limited to no intrapartum transfer, but percentages in the first 3 columns are calculated with the entire sample as the denominator, to be consistent with our previous publications. Because intrapartum transfers are not at risk of these outcomes, these rows were not repeated after dropping immediate intrapartum transfers (ie, those not admitted) in the PDR because the odds ratios would be exactly the same.
Models are limited to no known intrapartum death (deaths of unknown timing are retained); denominators for percentages are likewise limited to liveborn infants only.
Data presented from MANAStats only because only 1 death occurred in the home birth group in the PDR, rendering effect estimates unstable.
Models are limited to no known intrapartum death (deaths of unknown timing are not retained); denominators for percentages are likewise limited to liveborn infants only.
aOR indicates adjusted odds ratio; MANAStats, Midwives Alliance of North America Statistics; NICU, neonatal intensive care unit; PDR, Perinatal Data Registry.