Abstract
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.
Highlights
To 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
The debate on different birth settings in the Netherland has intensified since the national perinatal mortality rate showed to be one of the highest in Europe, the difference in perinatal mortality mainly occurs in preterm births [15, 16]
The prevalence of Big4 conditions was lower in planned home births (11.0%) compared to planned hospital births (13.1%) and planned place unknown (12.7%) (p < 0.001)
Summary
To 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. The challenge of obstetric care is to optimize maternal and child health outcomes and the mother’s experience of childbirth with the least possible interventions in the normal process [1] This challenge has led to a wide debate in recent years about relative benefits and risks of. While the proportion of home birth deliveries in the Netherlands has steadily decreased to 17% of all births [17], several high income countries consider the reintroduction of home births [18,19,20] This is based on claims of equal safety at lower intervention rates compared to hospital births where overtreatment might be present [20, 21]. This paper compares the intervention rates between planned home and planned hospital births, and determines whether these can be interpreted as over- or undertreatment by comparing adjusted perinatal mortality rates
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