Characteristics and outcome of unplanned out‐of‐institution births in Norway from 1999 to 2013: a cross‐sectional study

Abstract

Objective. To study the incidence, maternal characteristics and outcome of unplanned out-of-institution births (= unplanned births) in Norway. Design. Register-based cross-sectional study. Population. All births in Norway (n = 892 137) from 1999 to 2013 with gestational age ≥22 weeks. Methods. Analysis of data from the Medical Birth Registry of Norway from 1999 to 2013. Unplanned births (n = 6062) were compared with all other births (reference group). Results. The annual incidence rate of unplanned births was 6.8/1000 births and remained stable during the period of study. Young multiparous women residing in remote municipalities were at the highest risk of experiencing unplanned births. The unplanned birth group had higher perinatal mortality rate for the period, 11.4/1000 compared with 4.9/1000 for the reference group (incidence rate ratio 2.31, 95% confidence interval 1.82-2.93, p < 0.001). Annual perinatal mortality rate for unplanned births did not change significantly (p = 0.80) but declined on average by 3% per year in the reference group (p < 0.001). The unplanned birth group had a lower proportion of live births in all birthweight categories. Live born neonates with a birthweight of 750-999 g in the unplanned birth group had a more than five times higher mortality rate during the first week of life, compared with reference births in the same birthweight category. Conclusions. Unplanned births are associated with adverse outcome. Excessive mortality is possibly caused by reduced availability of necessary medical interventions for vulnerable newborns out-of-hospital.

On predicting time to completion for the first stage of spontaneous labor at term in multiparous women

“…However, other studies have found no association between maternal age and the duration of the first stage [13, 34]. In our previous study of unplanned out-of-institution births in Norway, we found that older women were less likely than younger women with the same parity to have unplanned out-of-institution deliveries [5]. We then speculated that this could be due to less vigorous labor or more precautions with age, and our findings from the present study support the latter.…”

“…We have studied unplanned out-of-institution births [5], which might occur because labor progresses faster than anticipated. A majority of the women experiencing such births are multiparous women with singleton, cephalic pregnancies in spontaneous labor at term.…”

Effect of hospital size and on-call arrangements on intrapartum and early neonatal mortality among low-risk newborns in Finland

“…However, centralization might lead to increasing numbers of unplanned out-of-hospital deliveries, as the distance to the birth unit becomes longer. This negates the positive effect of centralization, since perinatal mortality rate in unplanned out-ofhospital deliveries is shown to be at least twofold compared to hospital deliveries [12]. Also, a recent Finnish study showed that by decreasing the number of delivery units from 49 to 34, the rate of unplanned out-of-hospital deliveries doubled in two decades [8].…”

Izkušnje žensk ob nenačrtovanem porodu zunaj porodnišnice

“…Raziskava kaže, da se nekatere intervjuvanke, veliko bolj prvorodnice, ki so nenačrtovano rodile zunaj porodnišnice, niso zavedale pomembnosti časovne oddaljenosti in/ ali prepoznale znakov začetka poroda. Ugotovitve drugih raziskav kažejo, da je časovna oddaljenost do najbližje porodnišnice pomembno povezana z večjo pogostnostjo nenačrtovanega poroda (McLelland, et al, 2013) ter večjim deležem neonatalne mortalitete in morbiditete, ko govorimo o nenačrtovanem porodu (Scott & Esen, 2005;Blondel, et al, 2011;McLelland, et al, 2013;Gunnarsson, et al, 2014;Nguyen, et al, 2016). Čeprav je porod zunaj porodnišnice redek pojav tako pri nas kot v razvitem svetu (Blondel, et al, 2011;McLelland, et al, 2013;Gunnarsson, et al, 2014;Erlandsson, et al, 2015), je pomembno razumeti, kako ženske doživljajo takšen porod in kateri vidiki njenega doživljajskega sveta so v ospredju.…”

“…Ugotovitve drugih raziskav kažejo, da je časovna oddaljenost do najbližje porodnišnice pomembno povezana z večjo pogostnostjo nenačrtovanega poroda (McLelland, et al, 2013) ter večjim deležem neonatalne mortalitete in morbiditete, ko govorimo o nenačrtovanem porodu (Scott & Esen, 2005;Blondel, et al, 2011;McLelland, et al, 2013;Gunnarsson, et al, 2014;Nguyen, et al, 2016). Čeprav je porod zunaj porodnišnice redek pojav tako pri nas kot v razvitem svetu (Blondel, et al, 2011;McLelland, et al, 2013;Gunnarsson, et al, 2014;Erlandsson, et al, 2015), je pomembno razumeti, kako ženske doživljajo takšen porod in kateri vidiki njenega doživljajskega sveta so v ospredju. Porod je univerzalen dogodek, vendar pa je njegovo doživljanje zelo individualno (Lindgren & Erlandsson, 2010), kar potrjuje tudi raziskava, in se spreminja s sociopolitičnim kontekstom, v katerega je umeščen (Records & Wilson, 2011), zato je analiziranje vsakdanjega življenja in porodnih pričevanj žensk nujna in legitimna sestavina vrednosti, ki pomeni izziv »tradicionalni« vednosti, kot to imenuje Drglin (2007, p. 111).…”