title: Characteristics and outcome of unplanned out-of-institution births in Norway from 1999 to 2013: a cross-sectional study.
abstract: OBJECTIVE
  To study the incidence, maternal characteristics and outcome of unplanned out-of-institution births (= unplanned births) in Norway.
  
  
  METHODS
  Register-based cross-sectional study.
  
  
  METHODS
  All births in Norway (n = 892 137) from 1999 to 2013 with gestational age ≥22 weeks.
  
  
  METHODS
  Analysis of data from the Medical Birth Registry of Norway from 1999 to 2013. Unplanned births (n = 6062) were compared with all other births (reference group).
  
  
  RESULTS
  The annual incidence rate of unplanned births was 6.8/1000 births and remained stable during the period of study. Young multiparous women residing in remote municipalities were at the highest risk of experiencing unplanned births. The unplanned birth group had higher perinatal mortality rate for the period, 11.4/1000 compared with 4.9/1000 for the reference group (incidence rate ratio 2.31, 95% confidence interval 1.82-2.93, p < 0.001). Annual perinatal mortality rate for unplanned births did not change significantly (p = 0.80) but declined on average by 3% per year in the reference group (p < 0.001). The unplanned birth group had a lower proportion of live births in all birthweight categories. Live born neonates with a birthweight of 750-999 g in the unplanned birth group had a more than five times higher mortality rate during the first week of life, compared with reference births in the same birthweight category.
  
  
  CONCLUSIONS
  Unplanned births are associated with adverse outcome. Excessive mortality is possibly caused by reduced availability of necessary medical interventions for vulnerable newborns out-of-hospital.
authors.affiliation: Norwegian Air Ambulance Foundation, Drøbak, Norway; Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway.
authors.forename: Björn
authors.initials: B
authors.lastname: Gunnarsson
authors.forename: Alexander K
authors.initials: AK
authors.lastname: Smárason
authors.forename: Eirik
authors.initials: E
authors.lastname: Skogvoll
authors.forename: Sigurd
authors.initials: S
authors.lastname: Fasting
mesh_terms: D000328:Adult; D001719:Birth Certificates; D001724:Birth Weight; D003430:Cross-Sectional Studies; D005260:Female; D005865:Gestational Age; D006700:Home Childbirth / Q000706:statistics & numerical data*; D006801:Humans; D007226:Infant Mortality / Q000639:trends; D007231:Infant, Newborn; D008423:Maternal Age; D009664:Norway / Q000453:epidemiology; D011247:Pregnancy; D011256:Pregnancy Outcome / Q000453:epidemiology*; D018566:Pregnancy, High-Risk; D047928:Premature Birth / Q000453:epidemiology*; D012307:Risk Factors; D014187:Transportation of Patients / Q000706:statistics & numerical data*
keywords: Norway; birthing centers; delivery of health care; perinatal mortality; rural health services