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Research

Outcomes associated with planned place of birth among women with low-risk pregnancies

Eileen K. Hutton, Adriana Cappelletti, Angela H. Reitsma, Julia Simioni, Jordyn Horne, Caroline McGregor and Rashid J. Ahmed
CMAJ March 15, 2016 188 (5) E80-E90; DOI: https://doi.org/10.1503/cmaj.150564
Eileen K. Hutton
Department of Obstetrics and Gynecology (Hutton, Ahmed), The Michael G. DeGroote School of Medicine; Midwifery Education Program (Hutton, Cappelletti, Reitsma, Simioni, Horne, McGregor), Faculty of Health Sciences, McMaster University, Hamilton, Ont.
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  • For correspondence: huttone@mcmaster.ca
Adriana Cappelletti
Department of Obstetrics and Gynecology (Hutton, Ahmed), The Michael G. DeGroote School of Medicine; Midwifery Education Program (Hutton, Cappelletti, Reitsma, Simioni, Horne, McGregor), Faculty of Health Sciences, McMaster University, Hamilton, Ont.
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Angela H. Reitsma
Department of Obstetrics and Gynecology (Hutton, Ahmed), The Michael G. DeGroote School of Medicine; Midwifery Education Program (Hutton, Cappelletti, Reitsma, Simioni, Horne, McGregor), Faculty of Health Sciences, McMaster University, Hamilton, Ont.
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Julia Simioni
Department of Obstetrics and Gynecology (Hutton, Ahmed), The Michael G. DeGroote School of Medicine; Midwifery Education Program (Hutton, Cappelletti, Reitsma, Simioni, Horne, McGregor), Faculty of Health Sciences, McMaster University, Hamilton, Ont.
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Jordyn Horne
Department of Obstetrics and Gynecology (Hutton, Ahmed), The Michael G. DeGroote School of Medicine; Midwifery Education Program (Hutton, Cappelletti, Reitsma, Simioni, Horne, McGregor), Faculty of Health Sciences, McMaster University, Hamilton, Ont.
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Caroline McGregor
Department of Obstetrics and Gynecology (Hutton, Ahmed), The Michael G. DeGroote School of Medicine; Midwifery Education Program (Hutton, Cappelletti, Reitsma, Simioni, Horne, McGregor), Faculty of Health Sciences, McMaster University, Hamilton, Ont.
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Rashid J. Ahmed
Department of Obstetrics and Gynecology (Hutton, Ahmed), The Michael G. DeGroote School of Medicine; Midwifery Education Program (Hutton, Cappelletti, Reitsma, Simioni, Horne, McGregor), Faculty of Health Sciences, McMaster University, Hamilton, Ont.
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Abstract

Background: Previous studies have shown that planned home birth is associated with a decreased likelihood of intrapartum intervention with no difference in neonatal outcomes compared with planned hospital birth. The purpose of our study was to evaluate different birth settings by comparing neonatal mortality, morbidity and rates of birth interventions between planned home and planned hospital births in Ontario, Canada.

Methods: We used a provincial database of all midwifery-booked pregnancies between 2006 and 2009 to compare women who planned home birth at the onset of labour to a matched cohort of women with low-risk pregnancies who had planned hospital births attended by midwives. We conducted subgroup analyses by parity. Our primary outcome was stillbirth, neonatal death (< 28 d) or serious morbidity (Apgar score < 4 at 5 min or resuscitation with positive pressure ventilation and cardiac compressions).

Results: We compared 11 493 planned home births and 11 493 planned hospital births. The risk of our primary outcome did not differ significantly by planned place of birth (relative risk [RR] 1.03, 95% confidence interval [CI] 0.68–1.55). These findings held true for both nulliparous (RR 1.04, 95% CI 0.62–1.73) and multiparous women (RR 1.00, 95% CI 0.49–2.05). All intrapartum interventions were lower among planned home births.

Interpretation: Compared with planned hospital birth, planned home birth attended by midwives in a jurisdiction where home birth is well-integrated into the health care system was not associated with a difference in serious adverse neonatal outcomes but was associated with fewer intrapartum interventions.

  • Accepted October 26, 2015.
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Canadian Medical Association Journal: 188 (5)
CMAJ
Vol. 188, Issue 5
15 Mar 2016
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Outcomes associated with planned place of birth among women with low-risk pregnancies
Eileen K. Hutton, Adriana Cappelletti, Angela H. Reitsma, Julia Simioni, Jordyn Horne, Caroline McGregor, Rashid J. Ahmed
CMAJ Mar 2016, 188 (5) E80-E90; DOI: 10.1503/cmaj.150564

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Outcomes associated with planned place of birth among women with low-risk pregnancies
Eileen K. Hutton, Adriana Cappelletti, Angela H. Reitsma, Julia Simioni, Jordyn Horne, Caroline McGregor, Rashid J. Ahmed
CMAJ Mar 2016, 188 (5) E80-E90; DOI: 10.1503/cmaj.150564
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