Out-of-maternity deliveries in France: A nationwide population-based study

Abstract

Introduction In France, many maternity hospitals have been closed as a result of hospital restructuring in an effort to reduce costs through economies of scale. These closures have naturally increased the distance between home and the closest maternity ward for women throughout the country. However, studies have shown a positive correlation between this increase in distance and the incidence of unplanned out-of-maternity deliveries (OMD). This study was conducted to estimate the frequency of OMD in France, to identify the main risk factors and to assess their impact on maternal mortality and neonatal morbidity and mortality. Materials and methods We conducted a population-based observational retrospective study using data from 2012 to 2014 obtained from the French hospital discharge database. We included 2,256,797 deliveries and 1,999,453 singleton newborns in mainland France, among which, 6,733 (3.0‰) were OMD. The adverse outcomes were maternal mortality in hospital or during transport, stillbirth, neonatal mortality, neonatal hospitalizations, and newborn hypothermia and polycythemia. The socio-residential environment was also included in the regression analysis. Maternal and newborn adverse outcomes associated with OMD were analyzed with Generalized Estimating Equations regressions.

Relationship between out‐of‐facility deliveries and distance and travel time to delivery facilities in Hokkaido, Japan: An ecological study

“…The same French nationwide populationbased-study reported that the RR (95% CI) was 1.5 (1.4-1.5) for 16-30 km, 2.6 (2.4-2.9) for 31-45 km, and 3.9 (3.2-4.8) for 46-90 km with a reference of 0-15 km distance from the closest maternity unit. 5 However, contrary to those reports, the present results revealed that there was no significant increase in the rate of out-of-facility delivery in municipalities that were more than 30 km away from delivery facilities. In our study, the total number of deliveries was lower in municipalities that were farther away from delivery facilities, which may have made it difficult to find statistically significant differences.…”

“…Several national population‐based studies similar to this one have been conducted abroad. It was similar to the unplanned out‐of‐facility delivery rate of 1.4‰ for Finland with 1 052 559 deliveries 23 and 3.0‰ for France with 1 999 453 deliveries 5 . Delivery facilities are becoming centralized in Finland and France, with 9.9% and 25.3%, 5,24 respectively, living in locations more than 30 and 35 km away from the delivery facility.…”

“…It was similar to the unplanned out-of-facility delivery rate of 1.4‰ for Finland with 1 052 559 deliveries 23 and 3.0‰ for France with 1 999 453 deliveries. 5 Delivery facilities are becoming centralized in Finland and France, with 9.9% and 25.3%, 5,24 respectively, living in locations more than 30 and 35 km away from the delivery facility. In the present study, 7.8% of the deliveries in Hokkaido were performed at a minimum distance of approximately 30 km away from delivery facilities, which might be a shorter travel distance than that in France and Finland.…”

“…The incidence of out‐of‐facility deliveries has been reported in different countries, with Australia reporting 4.6‰, 4 France 3.0‰, 5 and Israel 15‰ 6 . In recent years, most Japanese have given birth in hospitals or midwifery centers, and those who deliver at home or in other facilities are rare.…”

Suspected Labour as a Reason for Emergency Medical Services Team Interventions in Poland—A Retrospective Analysis

“…Combier et al (2020) carried out a nationwide population-based study on unplanned out-of-maternity deliveries (OMD) in France. They found that women who delivered out-of-maternity had a higher risk of delivering before 37 weeks of gestation and that the risk of out-of-maternity delivery decreased for patients living in urban centres and in their surrounding suburbs [ 48 ]. In conclusion to their study, Pasternak et al (2018) noted that women with no caesarean deliveries and operative deliveries in their obstetric history are at greatest risk of unplanned out-of-hospital birth [ 32 ].…”