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Epidemiologist, Assistant Professor, Department of Obstetrics and Gynecology at Oregon Health & Science University
Assistant Professor, School of Nursing at Oregon Health & Science University
Associate Dean for Women’s Health Research and Policy, OHSU School of Medicine
Assistant Professor of Obstetrics and Gynecology at Harvard Medical School
Professor and Director of Obstetrics at Weill Medical College of Cornell University
Director - UCL Institute for Women's Health and Co-Director Policy Research Unit – Maternal Health and Care, University of Oxford
Emeritus Professor of Paediatrics and Family Practice, University of British Columbia
Physician & Social Entrepreneur, Executive Director of Costs of Care
Maternal health services researcher; Health policy analyst; Associate Professor University of Minnesota School of Public Health
Associate Professor, National Perinatal Epidemiology Unit at University of Oxford
Associate Professor at VU University Medical Center
Clinical Vice Chair at The Commission for the Accreditation of Birth Centers
Virgil G. Damon Professor, Department of Obstetrics and Gynecology, Columbia University, NY
Policy Officer at Royal Dutch Organisation of Midwives
Faculty in Nursing, Women's Studies and Midwife in OB/GYN Department at University of Michigan
Maternal and child health epidemiologist at OHSU
Deputy Editor, Journal of Midwifery & Women’s Health; Senior Editor, “Varney’s Midwifery”
Obstetrics and Gynecology Resident at University of California, San Francisco
The frequency of planned out-of-hospital birth in the United States has increased in recent years. The value of studies assessing the perinatal risks of planned out-of-hospital birth versus hospital birth has been limited by cases in which transfer to a hospital is required and a birth that was initially planned as an out-of-hospital birth is misclassified as a hospital birth.
We performed a population-based, retrospective cohort study of all births that occurred in Oregon during 2012 and 2013 using data from newly revised Oregon birth certificates that allowed for the disaggregation of hospital births into the categories of planned in-hospital births and planned out-of-hospital births that took place in the hospital after a woman’s intrapartum transfer to the hospital. We assessed perinatal morbidity and mortality, maternal morbidity, and obstetrical procedures according to the planned birth setting (out of hospital vs. hospital).
Planned out-of-hospital birth was associated with a higher rate of perinatal death than was planned in-hospital birth (3.9 vs. 1.8 deaths per 1000 deliveries, P = 0.003; odds ratio after adjustment for maternal characteristics and medical conditions, 2.43; 95% confidence interval [CI], 1.37 to 4.30; adjusted risk difference, 1.52 deaths per 1000 births; 95% CI, 0.51 to 2.54). The odds for neonatal seizure were higher and the odds for admission to a neonatal intensive care unit lower with planned out-of-hospital births than with planned in-hospital birth. Planned out-of-hospital birth was also strongly associated with unassisted vaginal delivery (93.8%, vs. 71.9% with planned in-hospital births; P<0.001) and with decreased odds for obstetrical procedures.
Perinatal mortality was higher with planned out-of-hospital birth than with planned in-hospital birth, but the absolute risk of death was low in both settings. (Funded by the Eunice Kennedy Shriver National Institute of Child Health and Human Development.)
Epidemiologist, Assistant Professor, Department of Obstetrics and Gynecology at Oregon Health & Science University
Assistant Professor, School of Nursing at Oregon Health & Science University
Associate Dean for Women’s Health Research and Policy, OHSU School of Medicine
Assistant Professor of Obstetrics and Gynecology at Harvard Medical School
Professor and Director of Obstetrics at Weill Medical College of Cornell University
Director - UCL Institute for Women's Health and Co-Director Policy Research Unit – Maternal Health and Care, University of Oxford
Emeritus Professor of Paediatrics and Family Practice, University of British Columbia
Physician & Social Entrepreneur, Executive Director of Costs of Care
Maternal health services researcher; Health policy analyst; Associate Professor University of Minnesota School of Public Health
Associate Professor, National Perinatal Epidemiology Unit at University of Oxford
Associate Professor at VU University Medical Center
Clinical Vice Chair at The Commission for the Accreditation of Birth Centers
Virgil G. Damon Professor, Department of Obstetrics and Gynecology, Columbia University, NY
Policy Officer at Royal Dutch Organisation of Midwives
Faculty in Nursing, Women's Studies and Midwife in OB/GYN Department at University of Michigan
Maternal and child health epidemiologist at OHSU
Deputy Editor, Journal of Midwifery & Women’s Health; Senior Editor, “Varney’s Midwifery”
Obstetrics and Gynecology Resident at University of California, San Francisco