…The authors’ primary outcome of interest was the rate of perinatal death, defined as stillbirth after 20 weeks’ gestation or death in the first 7 days of life, although stillbirths occurring before the onset of labor or in women who gave birth before 37 weeks were excluded from all groups.
The outcomes were analyzed by planned place of birth. Specific information on reasons for transfer does not seem to be available, but 78.8% of those women who planned a home birth with a midwife had one, and 96.9% of those who planned to be attended by a midwife in a hospital did so.
The authors found no statistically significant differences in the low risk of perinatal mortality between the 3 groups, at 0.35/1,000 for planned home birth, 0.57/1,000 for planned hospital birth with a midwife, and 0.64/1,000 for planned hospital birth with a physician. There were no deaths from 8-28 days of life. The authors also observed lower rates of obstetric interventions for planned home births with midwives than with either hospital group – the full text with tables of these secondary outcomes is freely available online.
The authors note the ability to compare place of birth without confounding from the type of provider (assuming physicians are more likely to conduct interventions than midwives), a strength of the Dutch study as well. But the authors also explain that “our findings do not extend to settings where midwives do not have extensive academic and clinical training.” They also note the possibility that some unknown difference between groups that influenced choice of birth place may have affected the outcomes, but that “our data indicate that screening for eligibility by registered midwives can safely support a policy of choice of birth setting.”
Amy Romano at Science & Sensibility and Lauredhel at Hoyden About Town have both written about the study, with a fair bit of discussion at both places.
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