Safety Data on Hospital vs Home and Birth Center Births in Oregon

WARNING: This article will cover the topic of fetal and infant death in numbers and statistics only. There will be no anecdotes.

*********

As a birth doula, I attend births in all settings—mostly hospital births, but also home births and birth center births. For the purposes of this article, I will be using the term “Community Birth” to refer to the combination of births that are planned for the home or birth center settings.

Parents-to-be are always concerned—rightly so—about the safety of their baby both inside and outside of the womb. When considering where to give birth, one of the most common questions is “What if there is an emergency?” or “What if something happens?” “Will my baby be safe?”

This is a legitimate question and one that I’m happy to report we have some data on!

Since 2012 the Oregon Health Authority has been collecting data on pregnancy outcomes sorted by Planned Place of Birth (regardless of where the baby or babies ended up being born). These data can now be easily accessed at their Planned Place of Birth Dashboard. For context, Oregon has some of the highest rates of Planned Community Birth in the nation, but as of 2022, it was still only about 5% of all births, meaning 95% of births in Oregon still take place in a hospital setting.

The Planned Place of Birth Dashboard includes many, many measures.

In this article I want to focus, however, on the rare, but serious outcomes of fetal death (defined as the death of any fetus weighing 350 grams or more or beyond 20 weeks gestation) and infant death (death within the first year of life) and look at the risk of fetal death, infant death, and both combined in Hospital Birth vs. Community Birth.

The Dashboard gives infant death and fetal death numbers in 3-year intervals only, so I collected the 3-year numbers and then I added up the live births for all 3 years. To get the total number of pregnancies beyond 20 weeks, I added the fetal death numbers to the live birth numbers and that was my denominator.

Then I took the number of deaths planned for the hospital and divided by that total number of pregnancies past 20 weeks and did the same for the deaths association with planned community birth.

Here is the chart of data:

These are the crunched numbers for hospital birth vs. community birth from 2014-2022

But, if you’re like me, this would make more sense in chart form:

*Fetal death is defined as the death of any fetus that weighs 350 grams or more or is over 20 weeks gestation. 

*Infant death is any death that happens in the first year of life

This is the comparison of death rates when fetal death and infant death are combined. 

As you can see, the risk of losing a baby after 20 weeks or any time in the first year is lower in the planned community birth group.

I can’t say for sure what the why is, though I have some speculative thoughts:

1) Risk levels - Community Birth is reserved for people who are low-risk overall. If a pregnancy was complicated, those births would be more likely to be planned for a hospital setting.

2) Demographics - Community Birth can be covered by insurance and by the Oregon Health Plan, but in the past it has been an out-of-pocket expense. Those who choose Community Birth may have higher levels of stability and family support than the general population and be at lower risk for pregnancy and postpartum complications.

3) Closer monitoring and individualized care in the Community Birth setting - Hospital birth prenatal visits are typically very short and hospital-based OBs and midwives have large client loads and may struggle to get to know each patient well. Community Birth prenatals tend to be longer (up to an hour), emotionally as well as physically supportive, and by the end of the pregnancy the care provider is very close to their patient. This way if anything feels off, the care provider may be more likely to take that concern seriously leading to a lower stillbirth risk.

4) Planning a Community Birth does not mean it will take place in a community setting - Here in Oregon, home birth and birth center birth is common enough that trusting, collaborative relationships exist between Community Birth Providers and Hospital Birth Providers. That mutual respect and collaboration means there’s little hesitance to transfer to a hospital setting in a timely manner. No time is lost placing judgment on the planned place of birth, prompt care is simply given. Being able to access a higher level of care in a timely manner (often before a situation becomes an emergency) is critical to good health outcomes.

I am absolutely certain there is more that I don’t fully and completely grasp. No setting is completely risk-free, but I think it’s clear to say that in Oregon, planning a birth at home or in a birth center is actually quite safe for a baby. And it has benefits for the birthing person as well, namely in the much, much lower cesarean rate (5.2% vs. 29.3% averaged over the 12 years of data from 2012-2023).

Thanks for nerding out with me! Feel free to contact me if you love a doula that can find you the numbers!