385 - Planned Out-of-Hospital Birth and Birth Outcomes

Publication Number: 385.6197

Marion E. Granger, University of South Carolina, Marietta, GA, United States; Ciaran S. Phibbs, Stanford University School of Medicine, Palo Alto, CA, United States; Scott A. Lorch, The Children's Hospital of Philadelphia, Philadelphia, PA, United States; Molly Passarella, Childrens Hospital of Philadelphia, Philadelphia, PA, United States; Nansi Boghossian, University of South Carolina, Columbia, SC, United States

Background: The incidence of planned out-of-hospital births in the United States has increased in recent years. However, studies comparing the outcomes of out-of-hospital births to hospital births often suffer from bias. This bias occurs when deliveries transferred to hospitals are misclassified as hospital births, despite being planned as out-of-hospital births at the onset of labor. Oregon is the only state that records the planned place of delivery on the birth certificate at the time labor begins.

Objective: To examine the association between the planned place of delivery and perinatal outcomes using Oregon vital records data.

Design/Methods: We examined singleton, non-breech infants without lethal anomalies born between 2012-2020 (n = 348,641). Vital records for all births were analyzed, with hospital record linkage for hospital births. Planned out-of-hospital births that were later transferred to a hospital were classified as planned out-of-hospital deliveries. Adjusted logistic regression was used to assess the association between planned out-of-hospital births and planned hospital births in relation to perinatal outcomes, resulting in adjusted odds ratios (aORs) and 95% confidence intervals (95% CI). We also examined the absolute differences in risk (ADR) as well as propensity score (PS) adjusted ADRs and associated 95% CIs.

Results: Birthing individuals with planned out-of-hospital births were more likely than those with planned hospital births to be non-Hispanic White, married, multiparous, overweight, ≥ 35 years old, have more than a high school education, self-pay insurance, and inadequate prenatal care, but were less likely to have hypertension, diabetes, and prior cesarean delivery (Table 1). Compared to planned hospital deliveries, planned out-of-hospital deliveries had increased odds of APGAR5 scores < 7 (aOR: 2.10; 95% CI: 1.93 – 2.30) or < 4 (aOR: 4.19; 95% CI: 3.68 – 4.77), neonatal seizures (aOR: 2.38; 95% CI: 1.12 – 5.06), any ventilator support (aOR: 1.13; 95% CI: 1.04 – 1.23), and unassisted vaginal births (aOR: 5.45; 95% CI: 5.06 – 5.86). However, the odds of NICU admission, operative deliveries, maternal ICU admission, blood transfusion, and severe perineal lacerations were decreased (Table 2). PS adjusted ADRs were very similar to the non-PS adjusted models.

Conclusion(s): Planned out-of-hospital births may result in increased risk of low APGAR5 scores, neonatal seizures, and ventilation. These results underscore the importance of informing birthing individuals about the potential risks associated with out-of-hospital births.

Trainee CV
Marion Granger Howard CV.pdf

Table 2. Unadjusted and Adjusted Odds Ratios and Absolute Difference in Risk with Associated 95% Confidence Intervals for Infant and Maternal Outcomes Based on Planned Birthing Location