Out-of-hospital deliveries have risen involving greater neonatal morbidity Risk factors in out-of-hospital deliveries in one University Hospital region in Finland

Aim: Most Finnish births take place in hospital, but out-of-hospital deliveries (OHDs) have increased. This study evaluated trends and reasons for OHDs in the Tampere University Hospital catchment area. Methods: The study cohort included all planned and unplanned OHDs in the Hospital area from 1996 to 2011; the control group comprised two hospital births for each OHD. Trends in incidence and risk factors for OHDs, including neonatal morbidities, were established and compared to the controls. Results: OHDs accounted for 67 (0.10%) of the 76 773 births in the area, the proportion remaining unchanged between 1996 and 2005, but then increasing. Risk factors associated with OHDs were smoking during pregnancy, short labour, higher number of previous births, single status, residence more than 35 kilometres from the delivery unit and fewer prenatal visits. OHD cases were more likely to be admitted to the neonatal care unit than controls and to be treated for suspected infections and hypothermia. Conclusion: Smoking, short duration of labour, a higher number of previous births, single status and longer distances from the delivery unit were associated with OHDs. Eight (12%) mothers had OHDs without antenatal care, and their infants had more neonatal morbidities.