Estimated minimal detectible relative risks.

BackgroundEvidence suggests that for low-risk pregnancies, planned home births attended by a skilled health professional in settings where such services are well integrated are associated with lower risk of intrapartum interventions and no increase in adverse health outcomes. Monitoring and updating evidence on the safety of planned home births is necessary to inform ongoing clinical and policy decisions.MethodsThis protocol describes a population-based retrospective cohort study which aims to compare risk of (a) neonatal morbidity and mortality, and (b) maternal outcomes and birth interventions, between people at low obstetrical risk with a planned home birth with a midwife, a planned a hospital birth with a midwife, or a planned hospital birth with a physician. The study population will include Ontario residents who gave birth in Ontario, Canada between April 1, 2012, and March 31, 2021. We will use data collected prospectively in a provincial perinatal data registry. The primary outcome will be severe neonatal morbidity or mortality, a composite binary outcome that includes one or more of the following conditions: stillbirth during the intrapartum period, neonatal death (death of a liveborn infant in the first 28 completed days of life), five-minute Apgar score

背景 有证据表明，在服务整合完善的医疗环境中，由熟练卫生专业人员陪护的计划性家庭分娩，针对低风险妊娠人群，可降低产时干预风险，且不会增加不良健康结局的发生风险。持续监测并更新计划性家庭分娩的安全性证据，可为当前临床与政策决策提供科学依据。

方法 本研究方案描述了一项基于人群的回顾性队列研究，旨在比较产科低风险人群中三类分娩场景的风险差异：(a) 新生儿发病率与死亡率；(b) 产妇结局与分娩干预措施。三类分娩场景分别为：助产士陪护的计划性家庭分娩、助产士陪护的计划性医院分娩，以及医师陪护的计划性医院分娩。本研究的研究人群为2012年4月1日至2021年3月31日期间，在加拿大安大略省境内分娩的安大略省居民。本研究将采用省级围产期数据登记库中前瞻性收集的数据。主要结局为严重新生儿发病率或死亡率，这是一项复合二分类结局，包含以下一项或多项情况：产时死胎、新生儿死亡（活产婴儿在出生后完整28天内死亡）、5分钟Apgar评分