HealthDay News — Planned out-of-hospital birth is associated with higher perinatal mortality and with increased odds of some adverse neonatal outcomes compared with planned in-hospital birth, according to a study published in the Dec. 31 issue of the New England Journal of Medicine.

Jonathan M. Snowden, PhD, from the Oregon Health and Science University in Portland, and colleagues used data from newly revised Oregon birth certificates in a population-based, retrospective cohort study of all births that occurred in Oregon during 2012 and 2013. Perinatal morbidity and mortality, maternal morbidity, and obstetrical procedures were assessed according to planned birth setting.

The researchers observed a higher rate of perinatal death for planned out-of-hospital birth versus in-hospital birth (3.9 vs. 1.8 deaths per 1,000 deliveries; P=0.003; odds ratio after adjustment for maternal characteristics and medical conditions, 2.43). Planned out-of-hospital births were associated with higher odds for neonatal seizure and lower odds of admission to a neonatal intensive care unit compared with planned in-hospital birth. There was a strong correlation for planned out-of-hospital birth with unassisted vaginal delivery (P<0.001) and with reduced odds for obstetrical procedures.

“Ultimately, women’s choices for place of delivery will be determined by the extent of their tolerance for risk and which risks they most want to avoid,” write the authors of an accompanying editorial.

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