To describe the incidence of perinatal death (defined as intrauterine fetal death at ≥28 weeks gestation or neonatal death at ≤28 days of age) in a population of hospital admissions from planned out-of-hospital births.
Retrospective review of admissions to labor and delivery and neonatal intensive care unit in one urban hospital from January 1, 2004, to December 31, 12 2008.
Academic tertiary medical center.
Chart review of patients meeting study criteria.
Antepartum and intrapartum hospitalizations from planned out-of-hospital births were included if they resulted in birth at study hospital. Maternal postpartum and/or neonatal hospital admissions were included if occurring ≤24 hours after planned out-of-hospital delivery. Eligible cases were reviewed and data entered into electronic database.
The total number of transfers represented 223 pregnancies, including six with twin gestation for a total N = 229 births. Transfer occurred at a variety of time points: antepartum, n = 31; intrapartum, n = 147; postdelivery maternal and neonate, n = 7; postpartum maternal only, n = 12; neonate only, n = 26. Live birth status was not available for six neonates in cases of maternal only or neonatal only transport. In 223 births with mortality data, eight deaths were characterized as follows: intrauterine fetal demise before 37 weeks gestation, n = 3; intrauterine fetal demise on or after 37 weeks gestation, n = 2; neonatal death within 7 days after birth, born at term, n = 2; neonatal death at age 8 to 28 days, born at term, n = 1.
The combined fetal and neonatal mortality rate was 8/223 (3.59%), yet comparison with available vital statistics requires a denominator that can account for total regional planned out-of-hospital births as well as area hospital transfers. One of the eight deaths was due to lethal congenital anomalies. Among the remaining seven, at least one of the following risk factors was present: preeclampsia or gestational hypertension, postdates gestation, or planned out-of-hospital vaginal breech delivery.
Conclusion/Implications for Nursing Practice
It is difficult to assess the safety of planned home birth in most of the United States because planned out-of-hospital births with hospital transfers are not identifiable by vital records. In Oregon, the number of out-of-hospital births increased from 2.2% of total births (1,003/46,453) in 2004 to 2.9% (1,431/49,492) in 2008. In the county where the study hospital is located, there were 11,027 total births, which includes 365 planned out-of-hospital births and 10 unplanned out-of-hospital births in 2008 (3.3% planned out-of-hospital births). These data underscore the imperative for comprehensive and prospective information on this population.