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Birth centers were associated with a higher risk of adverse infant outcomes, including neonatal death, according to a retrospective cohort study.

Neonatal death was more than four times more likely to occur in a freestanding birth center than in a hospital setting when delivered by a midwife (aOR 4.44, 95% CI 2.97-6.64), reported Amos Grünebaum, MD, of the Lenox Hill Hospital and Zucker School of Medicine at Hofstra/Northwell in Hempstead, New York, and colleagues.

First-time mothers had an even greater risk, being eight times more likely to experience neonatal death in birth centers (aOR 8.00, 95% 5.56-14.03), Grünebaum said in a presentation at the American College of Obstetricians and Gynecologists (ACOG) virtual meeting.

The researchers also found that birth center deliveries had an increased risk of neonatal seizures.

Grünebaum stated that "birth center births would be considered less safe compared to the hospital birth setting, whether the deliveries were by midwives or physicians in the hospital." He added that based on these findings, "it is therefore incorrect to state, as ACOG has done, that with respect to the settings of safety measures of neonatal outcomes, that hospitals and accredited birth centers are the safest settings for birth."

The researchers aimed to compare neonatal safety in freestanding birth center, at-home, and hospital births. They obtained data from the CDC , including births that occurred in the U.S. between 2016 and 2019. In addition to analyzing births by setting, they categorized hospital births by provider, either midwives or physicians.

The researchers assessed neonatal safety outcomes, including neonatal deaths, seizures, and low Apgar scores. They controlled for potential confounders such as maternal age, BMI, weight gain during pregnancy, type of insurance, and neonatal birthweight.

Grünebaum's group included more than 9 million births in their final analysis. More than 75% of mothers were between ages 24 and 35.

In addition to the increased risk of neonatal death, Grünebaum and colleagues found that birth centers had a greater risk of neonatal seizures (aOR 2.06, 95% CI 1.43-2.98), 5-min Apgar scores lower than 4 (aOR 8.39, 95% CI 7.69-9.17), and an Apgar score lower than 7 (aOR 2.06, 95% CI 2.80-3.19).

Neonatal deaths were highest in intended home births (OR 14.08; 95% CI 7.17, 27.67).

Grünebaum noted that adverse outcomes from births transferred from a birth center to a hospital are recorded as hospital outcomes, which may have limited the findings.

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