The aim of the doctoral dissertation study of Lic. Med. Katja Ovaskainen was to establish perinatal and maternal mortality and morbidity data, incidence, incidence trends, and risk factors related to out-of- hospital deliveries. The further aim was to compare the incidence of long-term morbidity and mortality of children by school age.
The study cohort was derived from the Medical Birth Register. This national register study included all children born in Finland between 1996 and 2013 (n = 1 053 802). Infants with no information on site of birth were excluded (n = 1046). The remaining infants were analyzed in three groups by site of birth: unplanned out-of-hospital (n = 1420), planned out-of-hospital (n = 197) and in- hospital (n = 1 051 139). Mortality and morbidity of infants were established by linking data from different health registers. For one study, the data was collected from the medical files at Tampere University Hospital between years 1996 and 2011 including all out-of-hospital deliveries (n = 67) in the catchment area and the reference group (n = 134).
The annual rate of unplanned out-of-hospital deliveries increased almost six-fold, from 46 to 260 per 100 000 births, during the study period, and the trend has continued to rise since. At the same time the number of delivery units decreased from 44 to 29. The rate of planned out-of-hospital deliveries increased almost five-fold, from 8.3 to 39.4 per 100 000 births.
Perinatal mortality was five times higher in unplanned out-of-hospital deliveries than in in-hospital deliveries and did not change during the study period. Perinatal mortality was rare in planned out-of-hospital deliveries, but adverse perinatal outcomes were overrepresented even in the group of low risk parturients. Independent risk factors for unplanned out-of-hospital deliveries were smoking during the pregnancy, alcohol and or/drug abuse, non-cohabitation, a small number of prenatal visits, previous deliveries, low birth weight, long distance to the delivery unit, short labor duration and giving birth outside the southern or southwestern area of Finland.
Risk factors for perinatal mortality among infants born in unplanned out-of- hospital deliveries were the out-of-hospital delivery itself, low birth weight, very preterm birth and being born in the eastern region of Finland. Risk factors for SHULQDWDO mortality or morbidity were low birth weight and preterm birth.
Long-term mortality did not differ from those who were born in hospitals.
The hazard ratios of asthma or allergic diseases and infections were decreased by 7 years of age in children born out-of-hospital. The risk of neurological or mental disorders by seven years of age in the groups born out-of-hospital seemed to be similar to that of children born in-hospital.
In conclusion the rate of out-of-hospital deliveries increased significantly during the study period. At the same time the number of delivery units decreased. Unplanned out-of-hospital deliveries had significantly higher perinatal mortality rates, especially among preterm and small infants. Among the planned out-of-hospital deliveries mortality was rare.
More than half of the planned out-of-hospital deliveries did not fulfill the current criteria for low- risk home delivery. Mortality by seven years of age did not differ between children born in-hospital and out-of-hospital. Children born outside a hospital were associated with a lower risk of asthma or allergies and infections than children born in-hospital. The risk of neurological or mental disorders seemed to be similar.
The doctoral dissertation of Lic. Med. Katja Ovaskainen in the field of paediatrics titled Out-of-Hospital Deliveries in Finland: A Nationwide register study will be publicly examined at the Faculty of Medicine and Health Technology of Tampere University at 12 o'clock on Friday 28 May, 2021. The venue is Arvo building auditorium F114, address: Arvo Ylpön katu 34. Docent Tuula Kaukola from th University of Oulu while Professor Per Ashorn will act as the custos.
The event can be followed via remote connection.
The dissertation is available online at
http://urn.fi/URN:ISBN:978-952-03-1976-2
Photo: Mimi & Nöde Photography