Research Issues in the Assessment of Birth Settings Report of a Study (1982) / Chapter Skim
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Appendix F: Vital Statistics and Nonhospital Births: A Mortality Study of Infants Born Out of Hospitals in Oregon Between 1975 and 1979
Appendix F: Vital Statistics and Nonhospital Births: A Mortality Study of Infants Born Out of Hospitals in Oregon Between 1975 and 1979
Pages 171-182
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From page 171... ...
An important preliminary step in designing these studies is to review existing data on births and subsequent deaths for infants born elsewhere than in a hospital. Mortality rates provide only crude indicators for measuring birth outcomes, and retrospective studies using data collected for entirely different purposes introduce many measurement problems.
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From page 172... ...
They found that the infant mortality rates for freestanding birth center deliveries were lower than those for all Washington State residents and that home delivery mortality rates were higher than state resident figures. The authors cautioned that biases are built into such comparisons because low-risk pregnancies should have lower mortality rates.
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From page 173... ...
The birth attendants indicated on the certificates were classified according to the following categoriesa Other and Licensed Attendant Midwife No Attendant Medical doctors Certified nurse Relatives Osteopaths midwives Friends Naturopath& Lay aidwives who Helpers Chiropractors identify thea- Followers of Christ Registered nurses selves as such Old Believers a.ergency -.dical Unknown attendants personnel No attendant These categories are certainly not ideal because there are significant differences in training and orientation, for exa.ple, between a naturopath and a pbysician or between a lay aidwife and a certified nurse •idwife (CMM)
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From page 174... ...
RESULTS Infant and Neonatal Death Rates for All Nonhospital Births Table 1 compares the figures for nonhospital births occurring in Oregon during the past decade (1970-1974 and 1975-1979) to the 1975-1979 rates for all Oregon residents and to the u.s.
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From page 175... ...
Infant and Neonatal Death Rates, by Attendant Marked differences in the reported figures by attendant are apparent in Table 2. Although the •other and Ro Attendant• category accounted for only 28 percent of the nonhospital deliveries, this group contributed to .ore than one-half of the neonatal deaths and nearly the same fraction of the infant deaths.
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From page 176... ...
with interpreting these rates are discussed in ter.a of ..asureaent biases, risk factors, and causes of death -- factors that may result in a misplaced emphasis on the attendants rather than on the populations served by those attendants. Reporting Bias The collection and coding of information from vital records introduces a number of biases in studies concerned with evaluating outco.es associated with nonhospital births.
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From page 177... ...
Therefore, the vital records identify many complicated deliveries as hospitalbased or physician-attended when the birth was actually planned to be nonhospital with a aidwife attendant. A bias in the opposite direction also exists because some of the nonhospital births may be deliveries for mothers who were unable to obtain medical assistance quickly when labor began.
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From page 178... ...
The large differences in the educational attainment and prenatal care of the populations served by the three attendant categories used in this analysis are an indication that other medical, social, and demographic characteristics must vary as well. Causes of Death The above discussion of maternal risks demonstrates a need to consider not only the providers of care but also the populations served.
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From page 179... ...
. Attendants Honhospital Births 3,006 1,597 1,795 6,398 Deaths by cause Pregnancy, delivery and per ina tal conditions Neonatal 6 1 8 15 Infant 7 1 8 16 Congenital anoaalies Neonatal 3 1 2 6 Infant 7 1 5 13 other causesa.2 Neonatal 1 2 6 9 Infant 12 5 21 38 Sudden Infant Death Syndraae g£ ~ 1~ 22 External causes (IIOtor vehicle, drowning, acci dent, assault, undetermined)
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From page 180... ...
The 21 infant deaths due to other causes in the •other and No Attendant• category translates to a cause-specific rate of 11.7 per 1,000 births, which is significantly different fro. the 4.0 per 1,000 births rate for licensed attendants (p <.OS)
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From page 181... ...
n risk factors associated with the population. The data for Oregon indicate that more than one-half of the infant deaths associated with nonhospital births occurred in a population that delivered without the aid of a licensed attendant or a midwife.
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