Are infants born under care of midwives at greater risk for death?

Infants born under the care of midwives to women who are at low risk for problems may be at more than twice the risk (relative risk [RR] 2.33, 1.12 to 4.83) for delivery-related perinatal death and at the same risk for admittance to the neonatal intensive care unit (NICU) as infants of women at high risk born under the supervision of obstetricians, according to a recent prospective cohort study conducted in the Netherlands.

The study involved more than 37,000 births, among which were 60 postpartum stillbirths, 22 intrapartum stillbirths, and 210 NICU admissions. Of the 210 neonates admitted to NICU, 17 died. The overall perinatal mortality rate was 2.62 per 1,000 babies delivered, and was significantly higher for nulliparous woman than for multiparous women (RR 1.65; 95% confidence interval [CI] 1.11 to 2.45).

Perhaps more startling is that those neonates referred to an obstetrician by a midwife during the labor process were at almost 4 times higher risk (RR 3.66, 1.58 to 8.46) for perinatal death than infants of women who started labor with an obstetrician. In addition, they were at 2.5-fold higher risk for NICU admission (RR 2.51, 1.87 to 3.37).

Evers AC, Brouwers HA, Hukkelhoven CW, et al. Perinatal mortality and severe morbidity in low and high risk term pregnancies in the Netherlands: prospective cohort study. BMJ. 2010;341:c5639.