Low-Risk Planned Out-of-Hospital Births: Characteristics and Perinatal Outcomes in Different Italian Birth Settings
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Design
2.2. Patient and Public Involvement
2.3. Setting
2.4. Sample
2.5. Statistical Analyses
3. Results
4. Discussion
5. Conclusions
Author Contributions
Funding
Acknowledgments
Conflicts of Interest
Ethics Approval
Data Sharing Statement
Appendix A
Cgharacteristics | Delivered at Home (n = 848) | Delivered in a Freestanding Midwifery Unit (n = 251) | Overall (N = 1099) | RD (95% CI) |
---|---|---|---|---|
Materna lcharacteristics | ||||
Age in years (mean ± SD) | 34.0 ± 4.7 | 34.2 ± 4.6 | 34.0 ± 4.7 | |
18–24 | 18 (2.1) | 5 (2.0) | 23 (2.1) | 1.1 (−15.9; 18.1) |
25–34 | 436 (51.4) | 125 (49.8) | 561 (51.1) | 1.1 (−3.8; 6.1) |
≥35 | 394 (46.5) | 121 (48.2) | 515 (46.8) | −1.2 (−6.2; 3.7) |
Residential area, n (%) | ||||
Large city | 291 (37.3) | 113 (51.1) | 404 (40.4) | −8.1 (−13.4; −2.8) |
Medium-size city | 333 (42.7) | 63 (28.5) | 396 (39.6) | 10.8 (5.9; 15.7) |
Small town | 155 (20.0) | 45 (20.4) | 200 (20.0) | 0.4 (−6.0; 6.8) |
Missing | 69 | 30 | 91 | |
Marital status, n (%) | ||||
Married and/or cohabiting | 729 (86.2) | 222 (89.6) | 951 (87.0) | −3.7 (−10.7; 3.2) |
Other | 119 (13.8) | 29 (10.4) | 148 (13.0) | 3.7 (−3.2; 10.7) |
Number of children, n (%) | ||||
First | 257 (31.1) | 113 (47.5) | 370 (34.8) | −11.6 (−17.1; −6.1) |
Second or more | 569 (68.9) | 125 (52.5) | 694 (65.2) | 13.1 (7.8; 18.4) |
Missing | 22 | 13 | 35 | |
First delivery >35 years, n (%) | ||||
Yes | 70 (8.3) | 35 (14.7) | 105 (9.9) | −11.6 (−21.0; −2.2) |
No | 756 (89.1) | 203 (85.3) | 959 (90.1) | 35.0 (27.8; 42.2) |
Missing | 22 | 13 | 35 | |
Level of education, n (%) | ||||
Primary | 18 (2.1) | 8 (3.2) | 26 (2.3) | −8.1 (−26.0; 9.8) |
Secondary | 257 (30.3) | 61 (24.3) | 318 (28.9) | 5.1 (−0.1; 10.4) |
Post-secondary | 568 (67.0) | 182 (72.5) | 750 (68.2) | −4.5 (−9.7; 0.7) |
Missing | 5 | − | 5 | |
Occupation status before index birth, n (%) | ||||
Working | 658 (77.9) | 206 (82.4) | 864 (78.9) | −4.7 (−10.5; 1.1) |
Not working | 186 (22.1) | 44 (17.6) | 230 (21.1) | 4.7 (−1.1; 10.5) |
Missing | 4 | 1 | 5 | |
Annual income (€), n (%) | ||||
<20.000 | 90 (13.2) | 23 (10.9) | 113 (12.6) | 2.8 (−5.1; 10.6) |
20–29.000 | 229 (33.5) | 58 (27.5) | 287 (32.1) | 3.6 (−1.9; 9.1) |
≥30.000 | 364 (53.3) | 130 (61.6) | 494 (55.3) | −6.3 (−11.3; −1.3) |
Missing | 165 | 40 | 205 | |
Food features, n (%) | ||||
Omnivorous | 665 (78.5) | 201 (81.1) | 866 (79.1) | −1.8 (−7.7; 4.2) |
Other | 182 (21.5) | 47 (18.9) | 229 (20.9) | 2.9 (−3.0; 8.9) |
Missing | 1 | 3 | 4 | |
Smoking, n (%) | ||||
Yes | 21 (2.5) | 15 (6.1) | 36 (3.3) | −19.5 (−35.8; −3.2) |
No | 817 (97.5) | 234 (93.9) | 1051 (96.7) | 13.2 (−0.6; 26.9) |
Missing | 10 | 2 | 12 | |
Partner characteristics | ||||
Age in years (mean ± SD) | 37.0 ± 6.0 | 37.5 ± 5.9 | 37.1 ± 6.0 | |
Level of education, n (%) | ||||
Primary | 62 (7.4) | 22 (7.4) | 84 (7.4) | −3.6 (−13.4; 6.1) |
Secondary | 384 (46.1) | 106 (46.1) | 490 (46.1) | 2.2 (−2.8; 7.2) |
Post-secondary | 387 (46.5) | 114 (46.5) | 501 (46.5) | 0.2 (−4.8; 5.1) |
Missing | 15 | 9 | 24 | |
Occupation status, n (%) | ||||
Working | 816 (98.2) | 242 (99.2) | 1058 (98.4) | −0.9 (−13.8; 12.0) |
Not working | 15 (1.8) | 2 (0.8) | 17 (1.6) | 11.2 (−4.3; 26.8) |
Missing | 17 | 7 | 24 |
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Population in Study Characteristics | Delivered at Home (n = 848) | Delivered in a Freestanding Midwifery Unit (n = 251) | Overall (N = 1099) | RR at Home Birth (95% CI) | F (p-Value) |
---|---|---|---|---|---|
Maternal characteristics | |||||
Age in years (mean ± SD), n (%) | 34.0 ± 4.7 | 34.2 ± 4.6 | 34.0 ± 4.7 | 1.04 (0.71) | |
18–24 | 18 (2.1) | 5 (2.0) | 23 (2.1) | 1.00 (0.81–1.25) | |
25–34 | 436 (51.4) | 125 (49.8) | 561 (51.1) | Reference | |
≥35 | 394 (46.5) | 121 (48.2) | 515 (46.8) | 0.98 (0.92–1.05) | |
Residential area, n (%) | |||||
Large city | 291 (37.3) | 113 (51.1) | 404 (40.4) | Reference | |
Medium-size city | 333 (42.7) | 63 (28.5) | 396 (39.6) | 1.17 (1.08–1.26) | |
Small town | 155 (20.0) | 45 (20.4) | 200 (20.0) | 1.08 (0.98–1.18) | |
Missing | 69 | 30 | 91 | ||
Marital status, n (%) | |||||
Married and/or cohabiting | 729 (86.2) | 222 (89.6) | 951 (87.0) | Reference | |
Other | 119 (13.8) | 29 (10.4) | 148 (13.0) | 1.07 (0.98–1.16) | |
Number of children, n (%) | |||||
First | 257 (31.1) | 113 (47.5) | 370 (34.8) | Reference | |
Second or more | 569 (68.9) | 125 (52.5) | 694 (65.2) | 1.18 (1.09–1.27) | |
Missing | 22 | 13 | 35 | ||
First delivery >35 years, n (%) | |||||
Yes | 70 (8.3) | 35 (14.7) | 105 (9.9) | 0.85 (0.74–0.97) | |
No | 756 (89.1) | 203 (85.3) | 959 (90.1) | Reference | |
Missing | 22 | 13 | 35 | ||
Level of education, n (%) | |||||
Primary | 18 (2.1) | 8 (3.2) | 26 (2.3) | Reference | |
Secondary | 257 (30.3) | 61 (24.3) | 318 (28.9) | 1.17 (0.90–1.52) | |
Post-secondary | 568 (67.0) | 182 (72.5) | 750 (68.2) | 1.09 (0.84–1.42) | |
Missing | 5 | - | 5 | ||
Occupation status before index birth, n (%) | |||||
Working | 658 (77.9) | 206 (82.4) | 864 (78.9) | Reference | |
Not working | 186 (22.1) | 44 (17.6) | 230 (21.1) | 1.06 (0.99–1.14) | |
Missing | 4 | 1 | 5 | ||
Annual income (€), n (%) | |||||
<20.000 | 90 (13.2) | 23 (10.9) | 113 (12.6) | Reference | |
20–29.000 | 229 (33.5) | 58 (27.5) | 287 (32.1) | 1.00 (0.90–1.12) | |
≥30.000 | 364 (53.3) | 130 (61.6) | 494 (55.3) | 0.93 (0.83–1.03) | |
Missing | 165 | 40 | 205 | ||
Food features, n (%) | |||||
Omnivorous | 665 (78.5) | 201 (81.1) | 866 (79.1) | Reference | |
Other | 182 (21.5) | 47 (18.9) | 229 (20.9) | 1.04 (0.96–1.12) | |
Missing | 1 | 3 | 4 | ||
Smoking, n (%) | |||||
Yes | 21 (2.5) | 15 (6.1) | 36 (3.3) | 0.75 (0.57–0.99) | |
No | 817 (97.5) | 234 (93.9) | 1051 (96.7) | Reference | |
Missing | 10 | 2 | 12 | ||
Partner characteristics | |||||
Age in years (mean ± SD) | 37.0 ± 6.0 | 37.5 ± 5.9 | 37.1 ± 6.0 | 1.01 (0.90) | |
Level of education, n (%) | |||||
Primary | 62 (7.4) | 22 (7.4) | 84 (7.4) | Reference | |
Secondary | 384 (46.1) | 106 (46.1) | 490 (46.1) | 1.06 (0.93–1.22) | |
Post-secondary | 387 (46.5) | 114 (46.5) | 501 (46.5) | 1.05 (0.91–1.20) | |
Missing | 15 | 9 | 24 | ||
Occupation status, n (%) | |||||
Working | 816 (98.2) | 242 (99.2) | 1058 (98.4) | Reference | |
Not working | 15 (1.8) | 2 (0.8) | 17 (1.6) | 1.14 (0.96–1.37) | |
Missing | 17 | 7 | 24 |
Place of Delivery | Delivered at Home (n = 569) | Delivered in a Freestanding Midwifery Unit (n = 125) | Overall (N = 694) | RR at Home Birth (95% CI) | Z or F (p-Value) |
---|---|---|---|---|---|
Home | 160 (28.2) | 7 (5.6) | 167 (24.1) | Reference | |
Freestanding midwifery unit | 16 (2.8) | 39 (31.2) | 55 (7.9) | 0.30 (0.20–0.46) | |
Hospital | 392 (69.0) | 79 (63.2) | 471 (68.0) | 0.87 (0.83–0.91) | |
Missing | 1 | 0 | 1 | ||
Mode of delivery, n (%) | |||||
Normal vaginal birth | 546 (96.0) | 118 (94.4) | 664 (95.7) | Reference | |
Operative delivery | 23 (4.0) | 7 (5.6) | 30 (4.3) | 0.93 (0.76–1.14) |
Characteristics | Delivered at Home (n = 848) | Delivered in a Freestanding Midwifery Unit (n = 251) | Overall (N = 1099) | RR at Home Birth (95% CI) | Z or F (p-Value) |
---|---|---|---|---|---|
Birth-related | |||||
Number of midwives at delivery, n (%) | |||||
1 | 92 (10.9) | 12 (4.8) | 104 (9.5) | 1.16 (1.08–1.26) | |
2 or more | 753 (89.1) | 238 (95.2) | 991 (90.5) | Reference | |
Gestational age, weeks (mean; SD) | 39.6; 1.0 | 39.7;1.0 | 39.6; 1.0 | Z = 0.89 (0.37) | |
Use of water in labor, n (%) | |||||
Yes | 367 (3.5) | 130 (48.0) | 487 (44.5) | Reference | |
No | 477 (56.5) | 130 (52.0) | 607 (55.5) | 1.04 (0.98–1.11) | |
Position in delivering, n (%) | |||||
Lying down | 106 (12.5) | 54 (21.5) | 160 (14.6) | 0.96 (0.84–1.1) | |
Squatting | 204 (24.0) | 92 (36.7) | 296 (26.9) | Reference | |
Kneeling | 46 (5.4) | 4 (1.6) | 50 (4.5) | 1.33 (1.19–1.49) | |
On all fours | 365 (43.0) | 62 (24.7) | 427 (38.9) | 1.24 (1.14–1.35) | |
On the side | 72 (8.5) | 34 (13.5) | 106 (9.6) | 0.99 (0.85–1.15) | |
Others | 55 (6.6) | 5 (2.0) | 60 (5.5) | 1.33 (1.19–1.48) | |
Induction of labor, n (%) | |||||
Yes | 76 (9.3) | 33 (13.6) | 109 (10.3) | 0.89 (0.79–1.02) | |
No | 741 (90.7) | 210 (86.4) | 951 (98.7) | Reference | |
Fetal vertex presentation, n (%) | |||||
Occiput-anterior | 816 (97.4) | 238 (96.0) | 1054 (97.0) | Reference | |
Occiput-posterior | 22 (2.6) | 10 (4.0) | 32 (3.0) | 0.89 (0.70–1.12) | |
Uterotonic agent use, n (%) | |||||
Yes | 173 (20.4) | 93 (37.1) | 266 (24.2) | 0.80 (0.73–0.88) | |
No | 675 (79.6) | 158 (62.9) | 833 (75.8) | Reference | |
Cord clamping, min (mean ± SD) | 101.7 (± 125.1) | 109.8 (± 86.1) | 103.6 (± 117.2) | F = 2.11 (0.0001) | |
Lotus, n (%) | |||||
Yes | 298 (36.0) | 67 (28.0) | 365 (34.2) | 1.08 (1.01–1.15) | |
No | 529 (64.0) | 172 (72.0) | 701 (65.8) | Reference | |
Birthweight, g (mean ± SD) | 3435.0 (± 451.1) | 3413.3 (± 391.9) | 3438.7 (± 402.2) | F = 1.32 (0.008) | |
Small for gestational age, n (%) | |||||
Yes | 111 (13.1) | 30 (12.0) | 141 (12.8) | 1.02 (0.93–1.12) | |
No | 737 (86.9) | 221 (88.0) | 958 (87.2) | Reference | |
Exclusive breastfeeding at 10 days, n (%) | |||||
Yes | 808 (97.4) | 239 (95.6) | 1047 (97.0) | Reference | |
No | 22 (2.6) | 10 (4.4) | 32 (3.0) | 0.89 (0.70–1.13) | |
Birth-outcomes | |||||
Postpartum hemorrhage, n (%) | |||||
≤500 mL | 746 (88.5 | 227 (90.8) | 973 (89.0) | Reference | |
>500 mL | 97 (11.7) | 23 (9.2) | 120 (11.0) | 1.05 (0.96–1.16) | |
Perineal tear, degree, n (%) | |||||
No | 417 (52.5) | 123 (49.4) | 594 (51.8) | Reference | |
1st | 278 (31.0) | 91 (36.5) | 369 (32.2) | 0.98 (0.91–1.05) | |
2nd | 147 (16.4) | 35 (14.1) | 182 (15.9) | 1.05 (0.96–1.14) | |
3rd | - | - | - | - | |
4th | 1 (0.1) | - | 1 (0.1) | - | |
Mother’s postpartum hospitalization (within 1 week of delivery), n | 5 | 1 | 6 | ||
Newborn’s hospitalization (within 1 week of birth), n | 16 | 3 | 19 |
Characteristics | Out-of-Hospital Birth (N = 1099) | Hospital Birth (N = 5495) | OR for Out-of-Hospital Birth (95% CI) | F (p-Value) |
---|---|---|---|---|
Maternal characteristics | ||||
Age in years (mean ± SD), n (%) | 34.0 ± 4.7 | 33.2 ± 5.0 | F = 1.15 (0.003) | |
18–24 | 23 (2.1) | 304 (5.5) | 0.38 (0.25–0.59) | |
25–34 | 561 (51.1) | 2830 (51.5) | Reference | |
≥35 | 515 (46.8) | 2361 (43.0) | 1.10 (0.97–1.26) | |
Residential area, n (%) | ||||
Large city | 404 (40.4) | 2045 (37.7) | Reference | |
Medium-size city | 396 (39.6) | 2727 (50.2) | 0.74 (0.63–0.85) | |
Small town | 200 (20.0) | 657 (12.1) | 1.54(1.27–1.87) | |
Missing | 99 | 66 | ||
Marital status, n (%) | ||||
Married and/or cohabiting | 951 (87.0) | 3696 (67.3) | Reference | |
Other | 148 (13.0) | 1798 (32.7) | 0.32(0.27–0.38) | |
Missing | 1 | |||
Number of children, n (%) | ||||
First | 370 (34.8) | 1398 (25.4) | Reference | |
Second or more | 694 (65.2) | 4097 (74.6) | 0.64 (0.56–0.74) | |
Missing | 35 | |||
First delivery >35 year of age, n (%) | ||||
Yes | 105 (9.9) | 274 (5.0) | 2.01 (1.59–2.55) | |
No | 959 (90.1) | 5221 (95.0) | Reference | |
Missing | 35 | |||
Level of education, n (%) | ||||
Primary | 26 (2.3) | 1212 (22.1) | Reference | |
Secondary | 318 (28.9) | 2436 (44.3) | 6.09 (4.06–9.13) | |
Post-secondary | 750 (68.2) | 1847 (33.6) | 18.93 (12.72–28.17) | |
Missing | 5 | |||
Occupation status before index birth, n (%) | ||||
Working | 864 (78.9) | 4414 (80.3) | Reference | |
Not working | 230 (21.1) | 1081 (19.7) | 1.09 (0.93–1.28) | |
Missing | 5 | |||
Partner characteristics | ||||
Level of education, n (%) | ||||
Primary | 84 (7.4) | 1678 (31.1) | Reference | |
Secondary | 490 (46.1) | 2476 (45.9) | 3.95 (3.11–5.02) | |
Post-secondary | 501 (46.5) | 1243 (23.0) | 8.05 (6.32–10.26) | |
Missing | 24 | 98 | ||
Occupation status before index birth, n (%) | ||||
Working | 1058 (98.4) | 5466 (98.5) | Reference | |
Not working | 17 (1.6) | 29 (0.5) | 3.03 (1.66–5.53) | |
Missing | 24 |
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Campiotti, M.; Campi, R.; Zanetti, M.; Olivieri, P.; Faggianelli, A.; Bonati, M. Low-Risk Planned Out-of-Hospital Births: Characteristics and Perinatal Outcomes in Different Italian Birth Settings. Int. J. Environ. Res. Public Health 2020, 17, 2718. https://doi.org/10.3390/ijerph17082718
Campiotti M, Campi R, Zanetti M, Olivieri P, Faggianelli A, Bonati M. Low-Risk Planned Out-of-Hospital Births: Characteristics and Perinatal Outcomes in Different Italian Birth Settings. International Journal of Environmental Research and Public Health. 2020; 17(8):2718. https://doi.org/10.3390/ijerph17082718
Chicago/Turabian StyleCampiotti, Marta, Rita Campi, Michele Zanetti, Paola Olivieri, Alice Faggianelli, and Maurizio Bonati. 2020. "Low-Risk Planned Out-of-Hospital Births: Characteristics and Perinatal Outcomes in Different Italian Birth Settings" International Journal of Environmental Research and Public Health 17, no. 8: 2718. https://doi.org/10.3390/ijerph17082718