Objective:  Describe the incidence of perinatal death (defined as intrauterine fetal death at >/= 28 weeks or neonatal death at </= 28 days of age) in a population of hospital admissions from planned out of hospital (OOH) births.

Design: Retrospective review of admissions to Labor & Delivery and Neonatal Intensive Care Unit in one urban hospital from 1/1/2004 to 12/31/2008. 

Setting:   Academic tertiary medical center

Patients/Participants: Chart review of patients meeting study criteria. 

Methods: Antepartum and intrapartum hospitalizations from planned OOH births were included if they resulted in delivery at study hospital. Maternal postpartum &/or neonatal hospital admissions were included if occurring </= 24 hours after planned OOH delivery.  Eligible cases were reviewed and data entered into electronic database.

Results:  Total number of transfers represented 223 pregnancies, including six with twin gestation for a total N=229 births.  Transfer occurred at a variety of time points:

Antepartum n= 31

Intrapartum n= 147

Post-delivery maternal and neonate n=7

Postpartum maternal only n=12

Neonate only n=26

Live birth status was not available for six neonates in cases of maternal only or neonatal only transport. In 223 births with mortality data, there were eight deaths characterized as follows:

Intrauterine fetal demise before 37 weeks n=3

Intrauterine fetal demise on or after 37 weeks n=2

Neonatal death within 7 days after birth, born at term n=2

Neonatal death at age 8-28 days, born at term n=1

Combined fetal & neonatal mortality rate was 8/223 (3.59%), yet comparison with available vital statistics requires a denominator that can account for total regional planned OOH births as well as area hospital transfers.  One of the eight deaths was due to lethal congenital anomalies.  Among the remaining seven, at least one of the following risk factors was present: pre-eclampsia or gestational hypertension, post-dates gestation, or planned OOH vaginal breech delivery.

Conclusion/Implications for nursing practice:  It is difficult to assess the safety of planned home birth in most of the United States, because planned OOH births with hospital transfers are not identifiable by vital records. In Oregon, the number of OOH births increased from 2.2% of total births (1003/46,453) in 2004 to 2.9% (1431/49,492) in 2008. In the county where the study hospital is located, there were 11,027 total births, which includes 365 planned OOH births and 10 unplanned OOH births in 2008 (3.3% planned OOH births). These data underscore the imperative for comprehensive and prospective information on this population.

Keywords: Home Birth; Perinatal mortality, midwifery