OHSU study sheds light on risks of giving birth in and out of a hospital setting

The out-of-hospital birth rate in Oregon is the highest of any state (4%) and nationally, more and more women are choosing to give birth at home. This national trend has drawn increased attention to an ongoing debate over whether it’s safe to give birth in an out-of-hospital setting. A new study published the Dec. 31 issue of the New England Journal of Medicine by OHSU researchers provides detailed answers to shed light on the issue.

The researchers collected data on nearly 8,000 pregnancies in Oregon in 2012 and 2013, comparing low-risk pregnancies only and examining birth certificates for information about where the mothers intended to give birth. Results showed that while overall perinatal mortality rates were low, planned out-of-hospital deliveries were 2.4 times more likely to result in the death of the baby either during the birth or in the first month of life. Out-of-hospital births were also associated with increased risk for neonatal seizures, the need to ventilate the baby, and the need for blood transfusion for the mother.  However, the study also showed cesarean rates are significantly higher (roughly 20%) for planned in-hospital births compared to planned out-of-hospital births which can result in complications and slower healing times for the mother. In-hospital-births were also associated with increased rates of additional obstetric interventions such as labor induction.

These findings indicate that while the overall risk for perinatal death is low in all settings, the stakes are high and women need to be better informed about the potential risks and trade-offs of birth setting preferences. The study’s authors make the case for better integrated maternity care systems where midwives can serve as primary care providers for healthy women, developing guidelines for determining which women are good candidates for home birth, and planning for a transfer system so women can be quickly and easily transported to the hospital if needed.

Given the nature of this debate, it’s not surprising that this study is receiving a lot of media attention. Read about what the New York Times and NPR have to say how these results may change the dialogue. For more detailed information on the study and researchers, read the press release here.

The OHSU research team that conducted the study included the following:

  • Jonathan M. Snowden, Ph.D., epidemiologist and assistant professor in the Department of Obstetrics and Gynecology in the OHSU School of Medicine and lead author of the study
  • Aaron B. Caughey, M.D., Ph.D., professor and chair in the OHSU Department of Obstetrics and Gynecology, associate dean for Women’s Health Research and Policy in the OHSU School of Medicine
  • Ellen Tilden, Ph.D., C.N.M., assistant professor at OHSU School of Nursing
  • Janice Snyder, R.N. of OHSU

This study was funded by the Eunice Kennedy Shriver National Institute of Child Health and Human Development at the National Institutes of Health, grant # K99 HD079658-01