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Perinatal death risk higher outside of hospital, but low overall

Babies born outside the hospital have a more than doubled chance of death during birth, though risk is low overall.
By Stephen Feller   |   Dec. 31, 2015 at 9:39 AM

PORTLAND, Ore., Dec. 31 (UPI) -- Giving birth outside a hospital was associated with a higher risk of perinatal death, and labor inside a hospital was linked to a higher risk for cesarean delivery or other medical intervention, according to a recent study.

Researchers at the Oregon Health and Science University report they found the overall risk of perinatal death was low, but was statistically significant for out-of-hospital births.

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An increasing number of women are choosing to have babies outside the hospital to prevent interventions such as C-section or chemical induction. Generally, these are discretionary decisions made by doctors based on circumstances, however some women seek specifically to avoid them.

The increase in home births has occurred rapidly -- the rate increased by 20 percent from 2004 to 2008, and by 24 percent from 2008 to 2012 -- matching an increase in C-sections, which one recent study pinned on doctors' attempts to practice defensive medicine and prevent adverse health events for mother or baby.

"While the overall risk for perinatal death was low in all settings, the stakes can be high," said Dr. Aaron Caughey, chair of the Department of Obstetrics and Gynecology at Oregon Health and Science University, in a press release. "As health care providers, we need to make sure women know what the trade-offs are so they can make an informed choice that reflects their birth preferences."

Researchers in the new study, published in the New England Journal of Medicine, conducted a population-based survey of all births in Oregon, which has the highest out-of-hospital birth rate in the United States, during 2012 and 2013, comparing healthy in-hospital and out-of-hospital births during the two yeas.

Overall, perinatal death occurs less than 0.5 percent of the time, though the chance for perinatal death was nearly 2.5 times greater outside the hospital -- 3.9 deaths per 1,000 deliveries outside the hospital, versus 1.8 deaths per 1000 deliveries in the hospital.

The C-section rate, relatively unsurprisingly, was 24.7 percent in the hospital, compared to just 5.3 percent outside the hospital. Mothers who planned to have their babies outside a hospital also had an increased risk for blood transfusions, but an overall decreased used of obstetric interventions such as C-section or induction.

"There is now consensus in the medical and midwifery communities that the U.S. C-section rate is too high, and the desire to avoid a C-section may shape women's choices when seeking out-of-hospital birth," said Dr. Ellen Tilden, an assistant professor at the Oregon Health and Science University. "It's really important that we strive to make birth safer in any setting, both through decreasing fetal and neonatal morbidity and mortality out of the hospital but also through supporting safe vaginal birth in hospitals."

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