Distance from Home Birth to Emergency Obstetric Services and Neonatal Outcomes: A Cohort Study

Abstract

Introduction Little is known about the relationship between distance from hospital services and the outcomes of planned home births. We examined whether greater driving distance from a hospital with continuous cesarean capability was associated with a higher risk of adverse neonatal outcome among individuals who were planning to give birth at home. Methods Using an intention‐to‐treat analysis, we conducted a population‐based cohort study of 11,869 individuals who planned to give birth at home in Ontario, Canada, between April 1, 2012, and March 31, 2015. We used postal codes to determine the driving time from maternal residence to the closest hospital offering level 2 or higher maternity care services (ie, hospital with continuous cesarean birth capability). We used log binomial regression analysis to compare the outcomes of individuals who planned a birth more than a 30‐minute drive from a level 2 hospital with those of individuals whose births were planned to occur within 30 minutes. We adjusted for maternal age, parity, gestational age, season, and maternal material deprivation quintile. Results We found no statistically significant difference in the rates of 5‐minute Apgar scores less than 7 (adjusted relative risk [aRR], 1.02; 95% CI, 0.95‐1.10; P = .58), perinatal mortality, meconium aspiration syndrome, and emergency medical service usage. Neonates born to individuals who planned to give birth at a greater distance from a hospital had a lower rate of neonatal intensive care unit admission (aRR, 0.6; 95% CI, 0.44‐0.81; P = .001). Discussion We found no increased risk of adverse neonatal outcomes for births that were planned to occur more than 30 minutes from a hospital. Our findings can be considered, along with individual risk factors and contextual factors, in decision making about the choice of home birth for individuals who live more than half an hour from a hospital with cesarean capacity.

Impact of obstetric unit closures, travel time and distance to obstetric services on maternal and neonatal outcomes in high-income countries: a systematic review

“…Evidence from travel time studies Description of included studies Fifteen studies explored the impact of travel time from a woman's home to an OU (see table 7). Two studies (one reported as an abstract only) were conducted in the UK, [29][30][31] three studies in France, [32][33][34] three studies (reported in five articles) in the Netherlands, [35][36][37][38][39] one study reported in two articles from Norway, 40 41 five studies in Canada [42][43][44][45][46] and one study in Japan. 47 Eleven studies were of a retrospective cohort design, one was a prospective cohort study, 39 one was a before-and-after design 47 and two were case-control studies.…”

“…Only singleton births were included in five studies. 30-32 35-38 42 One study 39 specifically enrolled women with postnatal haemorrhage after home birth, and one study 42 focused on planned home birth regardless of the actual place of birth.…”

“…The studies were heterogeneous in their travel time intervals. With the exception of one study in Canada, 42 longer time cut-off points were examined in studies from Norway, Japan and Canada compared with studies in other countries (all European). Travel duration was estimated using geographical mapping software in all studies.…”

“…Caesarean section (CS) (overall, or intrapartum) Five Canadian studies [42][43][44][45][46] reported CS rates (table 9). Across three studies, [43][44][45] cORs for CS rates were higher among women who lived closer to OUs with CS rates highest for women living less than 1 hour away compared with other categories (1-2 hours, 2-4 hours and >4 hours).…”

“…Seven studies examined PM, one from France, 32 one from the Netherlands 38 and five from Canada. [42][43][44][45][46] The French study 32 found no significant association between increasing travel time to the nearest OU and PM based on unadjusted data. However, in the Dutch study a longer travel time (20 min or more) was significantly associated with higher PM 38 (≥20 min vs <20 min, adjOR 1.66, 95% CI 1.59 to 1.74).…”