Oregon Public Health report on Planned OOH birth-related perinatal mortality

by faithgibson on May 13, 2016

in 21st Century Healthcare in US, Practice Issues - Safety & Cost

Link to

http://www.oregon.gov/oha/herc/CoverageGuidances/Planned-out-of-hospital-birth-11-12-15.pdf


Oregon-collected data on planned out-of-hospital birth
–> pages 33 & 34

In 2011, the Oregon Legislature passed House Bill 2380, which required the Oregon Public Health Division to add two questions to the Oregon Birth Certificate to determine planned place of birth and birth attendant, and to report annually on birth outcomes, including death, by location and attendant type.

The specific questions were:

“Did you go into labor planning to deliver at home or at a freestanding birthing center?

If yes, what was the planned primary attendant type at the onset of labor?”

In addition, for 2012, the Oregon Public Health Division conducted a special study of deaths in term infants (≥ 37 weeks’ gestation) intended to deliver out-of-hospital. The perinatal fatality analysis includes fetal and early neonatal deaths ≥ 37 weeks’ estimated gestational age through the first 6 days of life.

During 2012, 42,011 live term births occurred in Oregon. Of these 2,021 (4.8%) planned an out-of- hospital birth (home birth or freestanding birthing center).

In 2013 the Oregon Public Health Division published its first report on birth outcomes by planned place of birth and attendant.

Because this report specifically addresses home birth outcomes in the state of Oregon, a summary is presented here.

Key findings of term fetal and early neonatal deaths by planned place of birth and planned birth attendant include the following:

  •   Sixty-two term (≥ 37 weeks’ gestation) fetal deaths occurred in Oregon during 2012; 4  (6.5%) of these occurred among planned out-of-hospital births.
  •   Thirty term early neonatal deaths (during the first 6 days of life) occurred in Oregon during 2012; 4  (13.3%) of these occurred among planned out-of-hospital births.

page 33

 In total, 92 term fetal and early neonatal deaths occurred in Oregon during 2012; 8 (8.7%) occurred among planned out-of-hospital births. These 8 deaths underwent a fetal and neonatal mortality case review per published national guidelines.

{{ easy math –> 4.8% of total birth but 8.7% of total fetal/neonatal deaths }}

Key findings of the perinatal fatality case review of term births planned to occur out-of-hospital include the following:

  •    Four term fetal and four early neonatal deaths occurred during 2012 among women who planned to deliver out-of-hospital
  •    Two pregnancies had inadequate or no prenatal care
  •    Six of eight transferred to the hospital during labor
  •   One mother initially declined transfer during labor despite recommendation by birth attendant
    Six 
    of eight pregnancies did not meet published low-risk criteria for out-of-hospital birth*:

    • o More than 41 weeks gestation (4)
      o Twin gestation (2)
      o Morbid obesity (> 40 BMI) (1)
  •   Planned birth attendants: Certified Nurse Midwife (1), Licensed Direct-Entry Midwives (4), Unlicensed Midwife (1), Undetermined Licensure Midwife (1), and Naturopathic Physician (1)
  •   Median birth weight (3515 grams)
  •   Maternal characteristics were similar to the larger group of planned out-of-hospital births
  •   Chart review noted that, among perinatal deaths:

o Two pregnancies were twin gestations

o Four mothers declined prenatal ultrasound (to date pregnancy & identify pathology)

o Five mothers declined Group B strep testing

o Two mothers who tested positive declined GBS prophylaxis during labor 

Indications for transfer to a hospital from home or birthing center (multiple causes may apply):

  • loss of fetal heart tones (3)
  • prolonged labor (2)
  • decreased fetal movement (2)
  • malpresentation (2)

Planned attendants among these 6:

Certified Nurse Midwife (1), Licensed Direct-Entry Midwives (3), Unlicensed Midwife (1), and Naturopathic Physician (1)

 Causes of death and major contributing factors (more than one may apply):

o Hypoxic ischemic encephalopathy or cardiorespiratory failure (lack of blood flow) (3)
o Chorioamnionitis (infection in the womb) (3)
o Pre-existing or pregnancy-related maternal disease (2)
o Respiratory failure (1)



Link to

HEALTH EVIDENCE REVIEW COMMISSION (HERC) COVERAGE GUIDANCE: PLANNED OUT-OF-HOSPITAL BIRTH Approved 11/12/15

http://www.oregon.gov/oha/herc/CoverageGuidances/Planned-out-of-hospital-birth-11-12-15.pdf

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