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Planned community births, including transfers, were associated with higher odds of adverse perinatal outcomes like low APGAR scores and ventilator support compared to planned hospital births. Completed community births showed reduced intervention risks.

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Area of Science:

  • Obstetrics and Gynecology
  • Perinatal Health
  • Public Health

Background:

  • Community births, occurring outside hospitals, are often inaccurately recorded as hospital births when transfers occur.
  • Oregon's unique tracking of planned birth locations provides an opportunity to study perinatal outcomes associated with planned delivery settings.

Purpose of the Study:

  • To investigate the association between the planned place of delivery (hospital vs. community) and perinatal outcomes in Oregon.
  • To differentiate outcomes for completed community births versus community births transferred to hospitals.

Main Methods:

  • Population-based cohort study of singleton, non-breech infants born between 37 and 44 weeks gestation in Oregon (2012-2020).
  • Analysis compared planned hospital births with planned community births (including home/birth center deliveries and hospital transfers).
  • Adjusted logistic regression and propensity score analysis were used to assess associations with various perinatal outcomes.

Main Results:

  • Out of 348,641 births, 95.3% were planned hospital births and 4.7% were planned community births (14.7% of which involved transfer).
  • Planned community births showed higher odds of 5-minute APGAR scores below 7 and ventilator support compared to planned hospital births.
  • Transferred deliveries had increased odds of adverse outcomes and interventions, while completed community births had lower intervention rates.

Conclusions:

  • Completed community births were not associated with most adverse perinatal outcomes and had lower intervention rates.
  • Transferred community births were linked to higher odds of adverse perinatal outcomes and interventions.
  • Accurate classification of birth locations is crucial; misclassification may obscure risks associated with planned community births.