• Jonathan M Snowden, Ellen L Tilden, Janice Snyder, Brian Quigley, Aaron B Caughey, and Yvonne W Cheng.
• From the Departments of Obstetrics and Gynecology (J.M.S., B.Q., A.B.C.) and Public Health and Preventive Medicine (J.M.S.) and the School of Nursing (E.L.T., J.S.), Oregon Health and Science University, Portland; the Department of Surgery, University of California at Davis, Sacramento (Y.W.C.); and the Department of Obstetrics and Gynecology, Division of Maternal-Fetal Medicine, California Pacific Medical Center, San Francisco (Y.W.C.).
• N. Engl. J. Med. 2015 Dec 31;373(27):2642-53.

BackgroundThe 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.MethodsWe 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).ResultsPlanned 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.ConclusionsPerinatal 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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