Perinatale sterfte en morbiditeit tot 28 dagen bij geplande thuis- en ziekenhuisbevallingen

To compare the incidence of perinatal mortality and morbidity between planned home versus planned hospital births among low-risk women in midwife-led care at the onset of labour. A nationwide cohort study. Retrospective analysis of data from 3 nationwide registries over the years 2000-2009. Main outcome measures were intrapartum and neonatal death, Apgar scores and NICU admission within 28 days after birth. Of the total of 814,858 women, 466,041 (57.2%) had planned home birth and 276,908 (34.0) had planned hospital birth. For 71,909 women (8.8%) the planned place of birth was unknown. Combined intrapartum and neonatal death rates up to 28 days were 1.02‰ for planned home versus 1.09‰ for planned hospital births for primiparous women (adjusted OR: 0.99; 95%-CI: 0.79-1.24), and 0.59‰ versus 0.58‰ for multiparous women (adjusted OR: 1.16; 95%-CI 0.87-1.55). Children of multiparous women with a planned hospital birth had a significantly lower rate of Apgar scores < 7 (adjusted OR: 0.77; 95%-CI: 0,69-0,86) and a significantly higher rate of NICU admissions within 28 days (adjusted OR: 0.79; 95%-CI: 0.66-0.93). For children of primiparous women, we found no differences. We found no increased risk of adverse perinatal outcomes for planned home births among low risk women. Our results may only apply to regions where homebirths are well integrated into the maternity care system