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Study Authors
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Epidemiologist, Assistant Professor, Department of Obstetrics and Gynecology at Oregon Health & Science UniversityJonathan Snowden, PhD
Epidemiologist, Assistant Professor, Department of Obstetrics and Gynecology at Oregon Health & Science UniversityEpidemiologist, Assistant Professor, Department of Obstetrics and Gynecology at Oregon Health & Science University
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Assistant Professor, School of Nursing at Oregon Health & Science UniversityEllen Tilden, PhD, CNM
Assistant Professor, School of Nursing at Oregon Health & Science UniversityAssistant Professor, School of Nursing at Oregon Health & Science University
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Associate Dean for Women’s Health Research and Policy, OHSU School of MedicineAaron Caughey, MD, PhD
Associate Dean for Women’s Health Research and Policy, OHSU School of MedicineAssociate Dean for Women’s Health Research and Policy, OHSU School of Medicine
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Experts
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Assistant Professor of Obstetrics and Gynecology at Harvard Medical SchoolSarah Little, MD, MPH
Assistant Professor of Obstetrics and Gynecology at Harvard Medical SchoolAssistant Professor of Obstetrics and Gynecology at Harvard Medical School
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Professor and Director of Obstetrics at Weill Medical College of Cornell UniversityAmos Grünebaum, MD, FACOG
Professor and Director of Obstetrics at Weill Medical College of Cornell UniversityProfessor and Director of Obstetrics at Weill Medical College of Cornell University
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Director - UCL Institute for Women's Health and Co-Director Policy Research Unit – Maternal Health and Care, University of OxfordPeter Brocklehurst, MB.ChB, FRCOG, MSc, FFPH
Director - UCL Institute for Women's Health and Co-Director Policy Research Unit – Maternal Health and Care, University of OxfordDirector - UCL Institute for Women's Health and Co-Director Policy Research Unit – Maternal Health and Care, University of Oxford
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Emeritus Professor of Paediatrics and Family Practice, University of British ColumbiaMichael Klein, MD, CCFP, FCFP, FAAP (Neonatal-Perinatal), FCPS
Emeritus Professor of Paediatrics and Family Practice, University of British ColumbiaEmeritus Professor of Paediatrics and Family Practice, University of British Columbia
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Physician & Social Entrepreneur, Executive Director of Costs of CareNeel Shah, MD, MPP
Physician & Social Entrepreneur, Executive Director of Costs of CarePhysician & Social Entrepreneur, Executive Director of Costs of Care
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Maternal health services researcher; Health policy analyst; Associate Professor University of Minnesota School of Public HealthKaty Kozhimannil, PhD, MPA
Maternal health services researcher; Health policy analyst; Associate Professor University of Minnesota School of Public HealthMaternal health services researcher; Health policy analyst; Associate Professor University of Minnesota School of Public Health
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Associate Professor, National Perinatal Epidemiology Unit at University of OxfordJennifer Hollowell, PhD
Associate Professor, National Perinatal Epidemiology Unit at University of OxfordAssociate Professor, National Perinatal Epidemiology Unit at University of Oxford
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Associate Professor at VU University Medical CenterAnk de Jonge, RM, MSc, PhD
Associate Professor at VU University Medical CenterAssociate Professor at VU University Medical Center
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Clinical Vice Chair at The Commission for the Accreditation of Birth CentersSusan Stapleton, DNP, CNM, FACNM
Clinical Vice Chair at The Commission for the Accreditation of Birth CentersClinical Vice Chair at The Commission for the Accreditation of Birth Centers
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Virgil G. Damon Professor, Department of Obstetrics and Gynecology, Columbia University, NYCande Ananth, PhD, MPH
Virgil G. Damon Professor, Department of Obstetrics and Gynecology, Columbia University, NYVirgil G. Damon Professor, Department of Obstetrics and Gynecology, Columbia University, NY
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Policy Officer at Royal Dutch Organisation of MidwivesPien Offerhaus, RM, MSc, PhD
Policy Officer at Royal Dutch Organisation of MidwivesPolicy Officer at Royal Dutch Organisation of Midwives
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Faculty in Nursing, Women's Studies and Midwife in OB/GYN Department at University of MichiganLisa Low, PhD, CNM, FACNM, FAAN
Faculty in Nursing, Women's Studies and Midwife in OB/GYN Department at University of MichiganFaculty in Nursing, Women's Studies and Midwife in OB/GYN Department at University of Michigan
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Maternal and child health epidemiologist at OHSUKen Rosenberg, MD, MPH
Maternal and child health epidemiologist at OHSUMaternal and child health epidemiologist at OHSU
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Deputy Editor, Journal of Midwifery & Women’s Health; Senior Editor, “Varney’s Midwifery”Tekoa King, CNM, MPH
Deputy Editor, Journal of Midwifery & Women’s Health; Senior Editor, “Varney’s Midwifery”Deputy Editor, Journal of Midwifery & Women’s Health; Senior Editor, “Varney’s Midwifery”
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Lead Moderators
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Obstetrics and Gynecology Resident at University of California, San FranciscoMolly Siegel, MD
Obstetrics and Gynecology Resident at University of California, San FranciscoObstetrics and Gynecology Resident at University of California, San Francisco
About the Discussion
@NEJM Ask the Authors & Experts: Planned Out of Hospital Birth and Birth Outcomes
Special Article
Planned Out-of-Hospital Birth and Birth Outcomes
Background
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.
Methods
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).
Results
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.
Conclusions
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.)
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Study Authors
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Epidemiologist, Assistant Professor, Department of Obstetrics and Gynecology at Oregon Health & Science UniversityJonathan Snowden, PhD
Epidemiologist, Assistant Professor, Department of Obstetrics and Gynecology at Oregon Health & Science University
Epidemiologist, Assistant Professor, Department of Obstetrics and Gynecology at Oregon Health & Science University
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Assistant Professor, School of Nursing at Oregon Health & Science UniversityEllen Tilden, PhD, CNM
Assistant Professor, School of Nursing at Oregon Health & Science University
Assistant Professor, School of Nursing at Oregon Health & Science University
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Associate Dean for Women’s Health Research and Policy, OHSU School of MedicineAaron Caughey, MD, PhD
Associate Dean for Women’s Health Research and Policy, OHSU School of Medicine
Associate Dean for Women’s Health Research and Policy, OHSU School of Medicine
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Experts
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Assistant Professor of Obstetrics and Gynecology at Harvard Medical SchoolSarah Little, MD, MPH
Assistant Professor of Obstetrics and Gynecology at Harvard Medical School
Assistant Professor of Obstetrics and Gynecology at Harvard Medical School
-
Professor and Director of Obstetrics at Weill Medical College of Cornell UniversityAmos Grünebaum, MD, FACOG
Professor and Director of Obstetrics at Weill Medical College of Cornell University
Professor and Director of Obstetrics at Weill Medical College of Cornell University
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Director - UCL Institute for Women's Health and Co-Director Policy Research Unit – Maternal Health and Care, University of OxfordPeter Brocklehurst, MB.ChB, FRCOG, MSc, FFPH
Director - UCL Institute for Women's Health and Co-Director Policy Research Unit – Maternal Health and Care, University of Oxford
Director - UCL Institute for Women's Health and Co-Director Policy Research Unit – Maternal Health and Care, University of Oxford
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Emeritus Professor of Paediatrics and Family Practice, University of British ColumbiaMichael Klein, MD, CCFP, FCFP, FAAP (Neonatal-Perinatal), FCPS
Emeritus Professor of Paediatrics and Family Practice, University of British Columbia
Emeritus Professor of Paediatrics and Family Practice, University of British Columbia
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Physician & Social Entrepreneur, Executive Director of Costs of CareNeel Shah, MD, MPP
Physician & Social Entrepreneur, Executive Director of Costs of Care
Physician & Social Entrepreneur, Executive Director of Costs of Care
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Maternal health services researcher; Health policy analyst; Associate Professor University of Minnesota School of Public HealthKaty Kozhimannil, PhD, MPA
Maternal health services researcher; Health policy analyst; Associate Professor University of Minnesota School of Public Health
Maternal health services researcher; Health policy analyst; Associate Professor University of Minnesota School of Public Health
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Associate Professor, National Perinatal Epidemiology Unit at University of OxfordJennifer Hollowell, PhD
Associate Professor, National Perinatal Epidemiology Unit at University of Oxford
Associate Professor, National Perinatal Epidemiology Unit at University of Oxford
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Associate Professor at VU University Medical CenterAnk de Jonge, RM, MSc, PhD
Associate Professor at VU University Medical Center
Associate Professor at VU University Medical Center
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Clinical Vice Chair at The Commission for the Accreditation of Birth CentersSusan Stapleton, DNP, CNM, FACNM
Clinical Vice Chair at The Commission for the Accreditation of Birth Centers
Clinical Vice Chair at The Commission for the Accreditation of Birth Centers
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Virgil G. Damon Professor, Department of Obstetrics and Gynecology, Columbia University, NYCande Ananth, PhD, MPH
Virgil G. Damon Professor, Department of Obstetrics and Gynecology, Columbia University, NY
Virgil G. Damon Professor, Department of Obstetrics and Gynecology, Columbia University, NY
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Policy Officer at Royal Dutch Organisation of MidwivesPien Offerhaus, RM, MSc, PhD
Policy Officer at Royal Dutch Organisation of Midwives
Policy Officer at Royal Dutch Organisation of Midwives
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Faculty in Nursing, Women's Studies and Midwife in OB/GYN Department at University of MichiganLisa Low, PhD, CNM, FACNM, FAAN
Faculty in Nursing, Women's Studies and Midwife in OB/GYN Department at University of Michigan
Faculty in Nursing, Women's Studies and Midwife in OB/GYN Department at University of Michigan
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Maternal and child health epidemiologist at OHSUKen Rosenberg, MD, MPH
Maternal and child health epidemiologist at OHSU
Maternal and child health epidemiologist at OHSU
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Deputy Editor, Journal of Midwifery & Women’s Health; Senior Editor, “Varney’s Midwifery”Tekoa King, CNM, MPH
Deputy Editor, Journal of Midwifery & Women’s Health; Senior Editor, “Varney’s Midwifery”
Deputy Editor, Journal of Midwifery & Women’s Health; Senior Editor, “Varney’s Midwifery”
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Lead Moderators
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Obstetrics and Gynecology Resident at University of California, San FranciscoMolly Siegel, MD
Obstetrics and Gynecology Resident at University of California, San Francisco
Obstetrics and Gynecology Resident at University of California, San Francisco
