title: Out-of-hospital deliveries have risen involving greater neonatal morbidity: Risk factors in out-of-hospital deliveries in one University Hospital region in Finland.
abstract: OBJECTIVE
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: School of Medicine Doctoral Programme, University of Tampere, Tampere, Finland.|Department of Pediatrics, Kanta-Häme Central Hospital, Hämeenlinna, Finland.
authors.forename: Katja
authors.initials: K
authors.lastname: Ovaskainen
authors.affiliation: Department of Neonatology, Tampere University Hospital, Tampere, Finland.
authors.forename: Riitta
authors.initials: R
authors.lastname: Ojala
authors.affiliation: National Institute for Health and Welfare, Helsinki, Finland.|Nordic School of Public Health, Gothenburg, Sweden.
authors.forename: Mika
authors.initials: M
authors.lastname: Gissler
authors.affiliation: Science Center, Pirkanmaa Hospital District, Tampere, Finland.|School of Health Sciences, University of Tampere, Tampere, Finland.
authors.forename: Tiina
authors.initials: T
authors.lastname: Luukkaala
authors.affiliation: Department of Neonatology, Tampere University Hospital, Tampere, Finland.
authors.forename: Outi
authors.initials: O
authors.lastname: Tammela
mesh_terms: D000046:Academic Medical Centers / Q000706:statistics & numerical data*; D036861:Delivery, Obstetric / Q000706:statistics & numerical data*; D005387:Finland; D006801:Humans; D007231:Infant, Newborn; D036801:Parturition; D012189:Retrospective Studies; D012307:Risk Factors
keywords: Hypothermia; Out-of-hospital delivery; Prenatal visits; Travel distance and travel time to delivery unit