Department of Pediatrics, University of Texas Medical Branch, Galveston, TX, USA.
J Perinatol. 2010 Sep;30(9):622-7. doi: 10.1038/jp.2010.12. Epub 2010 Feb 25.
Home births attended by certified nurse midwives (CNMs) make up an extremely small proportion of births in the United States (<1.0%) and are not supported by the American College of Obstetrics and Gynecology (ACOG). The primary objective of this analysis was to examine the safety of certified nurse midwife attended home deliveries compared with certified nurse midwife in-hospital deliveries in the United States as measured by the risk of adverse infant outcomes among women with term, singleton, vaginal deliveries.
United States linked birth and infant death files for the years 2000 to 2004 were used for the analysis. Adverse neonatal outcomes including death were determined by place of birth and attendant type for in-hospital certified nurse midwife, in-hospital 'other' midwife, home certified nurse midwife, home 'other' midwife, and free-standing birth center certified nurse midwife deliveries.
For the 5-year period there were 1 237 129 in-hospital certified nurse midwife attended births; 17 389 in-hospital 'other' midwife attended births; 13 529 home certified nurse midwife attended births; 42 375 home 'other' midwife attended births; and 25 319 birthing center certified nurse midwife attended births. The neonatal mortality rate per 1000 live births for each of these categories was, respectively, 0.5 (deaths=614), 0.4 (deaths=7), 1.0 (deaths=14), 1.8 (deaths=75), and 0.6 (deaths=16). The adjusted odds ratio (95% confidence interval) for neonatal mortality for home certified nurse midwife attended deliveries vs in-hospital certified nurse midwife attended deliveries was 2.02 (1.18, 3.45).
Deliveries at home attended by CNMs and 'other midwives' were associated with higher risks for mortality than deliveries in-hospital by CNMs.
由认证护士助产士（CNM）接生的家庭分娩在美国的分娩中所占比例极小（<1.0%），并且得不到美国妇产科医师学会（ACOG）的支持。本分析的主要目的是检查在美国，与 CNM 住院分娩相比，由 CNM 在家中分娩的安全性，这是通过具有足月、单胎、阴道分娩的妇女的不良婴儿结局风险来衡量的。
本分析使用了 2000 年至 2004 年美国链接的出生和婴儿死亡档案。通过分娩地点和住院 CNM、住院“其他”助产士、家庭 CNM、家庭“其他”助产士和独立分娩中心 CNM 的助产士类型来确定不良新生儿结局，包括死亡。
在 5 年期间，有 1 237 129 名住院 CNM 分娩；17 389 名住院“其他”助产士分娩；13 529 名家庭 CNM 分娩；42 375 名家庭“其他”助产士分娩；25 319 名分娩中心 CNM 分娩。这些类别中每 1000 例活产的新生儿死亡率分别为 0.5（死亡=614）、0.4（死亡=7）、1.0（死亡=14）、1.8（死亡=75）和 0.6（死亡=16）。家庭分娩的调整后比值比（95%置信区间）与住院分娩的 CNM 分娩相比，家庭分娩的新生儿死亡率为 2.02（1.18，3.45）。
由 CNM 和“其他助产士”在家中接生的分娩与由 CNM 在医院接生的分娩相比，死亡率风险更高。
