Planned Out-of-Hospital Birth, Oregon

Background: Compared to the U.S., Oregon has a high rate of out-of-hospital births. Little is known about women who plan out-of-hospital births and ultimately deliver in-hospital. To better understand birth outcomes associated with planned out-of-hospital births, Oregon lawmakers required planned birth place on birth certificates beginning in 2012. Oregon is the only state known to collect this data on the birth certificate.

Methods: Maternal demographics and birth outcomes were analyzed by planned place of birth (in- or out-of-hospital) using combined 2012 and 2013 birth certificate data. Early neonatal deaths were identified using matched death and birth certificate data.

Results: Over four percent of Oregon births were planned out-of-hospital; 17% of these occurred in-hospital. Women who planned out-of-hospital births were significantly more likely to be older, married, non-smokers, non-Hispanic white, and college-educated. Women who planned out-of-hospital births experienced fewer medical interventions including induction and augmentation of labor (relative risk [RR]: 0.60), epidural or spinal anesthesia (RR: 0.38), and cesarean section (RR: 0.76). There were eight early neonatal deaths among the planned out-of-hospital births. Six did not meet low-risk criteria (i.e. gestational age ≥36 and ≤41 weeks, singleton, vertex, and absence of preexisting or pregnancy-related maternal disease).

Conclusions: While planned out-of-hospital births in Oregon generally have a lower risk profile, the majority of early neonatal deaths among planned out-of-hospital deliveries did not meet low-risk criteria. Appropriate risk stratification and collaboration between parents planning out-of hospital birth, birth attendants, and public health is needed to optimize outcomes of infants for planned out-of-hospital births.