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Neonatal mortality in the United States is related to location of birth (hospital vs home) rather than the type of birth attendant

American Journal of Obstetrics and Gynecology Feb 14, 2020

Grünebaum A, et al. - Researchers sought to determine the safety of birth in the United States by comparing the neonatal mortality outcomes of two locations, hospital birth, and home birth, by four types of attendants: hospital midwife; certified nurse-midwife at home; direct-entry (“other”) midwife at home; and attendant at home not identified. The most current US Centers for Disease Control Linked Birth and Infant Death Records for 2010-2017, were used to estimate neonatal mortality (neonatal death days 0- 27 after birth) for single, term (37+ weeks), normal weight ( > 2,499 gms) infants for planned home births and hospital births by birth attendants. The analysis revealed variation in the safety of birth in the United States by location and attendant. Relative to US hospital births attended by a certified nurse-midwife, planned US home births for all types of attendants are identified as a less safe setting of birth, particularly when identified risk factors are considered. They suggested no differential effect of the type of midwife attending US planned home birth on reducing the absolute and relative risk of neonatal mortality of planned home birth because there was no statistically significant difference in outcomes of US planned home births attended by direct-entry midwives or by certified nurse-midwives.
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