Neonatal deaths in Alabama. III. Out-of-hospital births, 1940-1980

Out-of-hospital births in Alabama are characterized with special emphasis on the period from 1970 to 1980. Women having an out-of-hospital birth were more likely to be nonwhite, aged greater than or equal to 35, and multiparous and to have little or no prenatal care. However, within the group of women having out-of-hospital delivery, characteristics which predicted neonatal death included being white, aged less than 20, primiparous, and unmarried and having little or no prenatal care. Both the risk factors for and outcomes of out-of-hospital birth differed markedly by race. In all, out-of-hospital births, which declined from 25% to 0.5% of all births from 1940 to 1980, were associated with a twofold increase in neonatal mortality. The major care provider for out-of-hospital births, the "granny" midwife, was found to have little knowledge about, or ability to provide, modern obstetric care. High-risk status of the patients, limited capability of the care-givers, and lack of appropriate medical resources are suggested as the likely reasons for the excess neonatal mortality in out-of-hospital births.