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Heys S, Main C, Humphreys A, Torrance R. Displaced risk. Keeping mothers and babies safe: a UK ambulance service lens. Br Paramed J 2023; 8:52-56. [PMID: 37674917 PMCID: PMC10477820 DOI: 10.29045/14784726.2023.9.8.2.52] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/08/2023] Open
Abstract
Aim The aim of this professional practice paper is to provide a critical commentary on displaced risk among perinatal and neonatal patients attended to by the ambulance service. Background NHS services across the United Kingdom are currently facing unprecedented demand and increased scrutiny in their ability to provide safe and personalised care to patients. While current focus in the system centres around addressing social care demand, hospital bed capacity, planned care waiting times, staffing and ambulance handover delays, a less explored cohort of patients impacted by the current healthcare crisis is perinatal and neonatal populations attended to by the ambulance service. Little focus has been paid within national agendas to the care provided to women and babies outside of planned maternity and obstetric care. A case is presented to highlight the importance of considering urgent and emergency maternity care provision provided by the ambulance service, and the impact of 'displaced risk' due to the current pressures within healthcare systems. Conclusion Placed in a national context, drawing upon current independent reviews into maternity services, national transformation agendas and the most recent MBRRACE-UK confidential enquiry into maternal deaths and morbidity, a case is made to commissioners and Integrated Care Systems to focus on and invest in the unplanned pre-hospital care of maternity and neonatal patients. Recognition of the ambulance service as a key provider of care to this cohort of patients is paramount, calling on services and systems to work together on realising and addressing displaced risk for perinatal populations across the United Kingdom. A system approach that acknowledges the need for high-quality care at every point of contact and equitability in access to services for pregnant, postpartum and neonatal patients is vital.
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Affiliation(s)
- Stephanie Heys
- North West Ambulance Service NHS Trust; University of Central Lancashire https://orcid.org/0000-0002-4379-9022
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DAĞ TÜZMEN H, ALTUNTUĞ K. Planlanmamış Evde Doğumun Maternal ve Neonatal Sonuçlar Üzerine Etkisi: Sistematik Derleme. DOKUZ EYLÜL ÜNIVERSITESI HEMŞIRELIK FAKÜLTESI ELEKTRONIK DERGISI 2022. [DOI: 10.46483/deuhfed.928663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Giriş: Planlanmamış ev doğumlarının maternal ve neonatal sonuçlar üzerinde etkisinin olduğu bilinmektedir.
Amaç: Bu derleme, planlanmamış ev doğumlarının maternal ve fetal sonuçlar üzerine etkisini güncel çalışmalarla gözden geçirmek ve planlanmamış ev doğumlarının olumlu ve olumsuz yönlerini ortaya koymak amacıyla yapılmıştır.
Yöntem: Sistematik derleme niteliğinde olan çalışma, 28 Ağustos- 27 Eylül 2020 tarihlerinde, Türkçe ve
İngilizce dizinler taranarak yapılmıştır. Türk Medline, Sciencedirect, Google Akademik, Pubmed, Cochrane
ve Ulusal Tez Merkezi veri tabanları kullanılarak ‘evde doğum, hastane dışı, hastane dışı doğum, evde
doğum-hastane dışı doğum ve neonatal sonuçlar, evde doğum-hastane dışı doğum ve maternal sonuçlar’ anahtar kelimeleri ile aranmıştır.
Bulgular: Bu sistematik derlemede planlanmamış evde doğumların maternal ve neonatal sonuçları olumsuz etkilediği saptanmıştır. Kadınların; yaş, gebelik sayısı, gebelik haftası, medeni durum ve sosyoekonomik özelliklerinin doğumların hastane dışında gerçekleşme olasılığı üzerinde etkili olduğu, planlanmamış evde doğum yapan kadınlarda daha fazla olumsuz maternal sonuç bildirildiği görülmüştür. Planlanmamış evde doğumlar sonucunda dünyaya gelen yeni doğanların doğum ağırlıklarının düşük olduğu, prematüre olma risklerinin yüksek olduğu, hastanede yatış sürelerinin daha uzun olduğu, klinik komplikasyon görülme oranları ile neonatal morbidite ve mortalite oranlarının daha yüksek olduğu belirlenmiştir. Planlanmamış evde doğum yapan kadınların yetersiz antenatal bakım aldığı saptanmıştır.
Sonuç: Bu derlemenin sonucunda, kadınların maternal özelliklerinin hastane dışında doğum yapma olasılıklarını etkilediği, planlanmamış evde doğumların olumsuz maternal ve neonatal sonuçların yaşanma riskini artırdığı ve yetersiz antenatal bakım alma ile ilişkili olduğu bulunmuştur.
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Spring Walsh B, Gardiner FW, Bloxsome D, Ford D, Mills BW, Laws SM. A Cohort Comparison Study on Women in Threatened Preterm Labor Given Nifedipine or Nifedipine and Salbutamol Tocolysis in Air Medical Retrieval. Air Med J 2022; 41:298-302. [PMID: 35595338 DOI: 10.1016/j.amj.2022.02.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2021] [Revised: 02/06/2022] [Accepted: 02/10/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVE Women with threatened preterm labor in remote Australia often require tocolysis in the prevention of in-flight birth during air medical retrieval. However, debate exists over the tocolytic choice. METHODS A retrospective analysis was undertaken on data containing women who required air medical retrieval for threatened preterm labor within Western Australia between the years 2013 and 2018. RESULTS A total number of 236 air medical retrievals were deemed suitable for inclusion; 141 received nifedipine, and 95 women received salbutamol + nifedipine. Tocolytic efficaciousness was reported in 151 cases, proportionally more (P < .05) from the women who received salbutamol + nifedipine (n = 68, 71.6%) compared with the women who received nifedipine only (n = 83, 58.9%). Those receiving salbutamol + nifedipine were more likely to suffer maternal tachycardia (n = 87 [91.6%] vs. n = 62 [44.0%]), fetal tachycardia (n = 26 [27.4%] vs. n = 13 [9.2%]), nausea (n = 17 [17.9] vs. n = 5 [3.55%]), and vomiting (n = 12 [12.6%] vs. n = 2 [1.4%]). Three women who received salbutamol + nifedipine had serious side effects including echocardiographic changes, chest pain, and metabolic and lactic acidosis. CONCLUSION Salbutamol + nifedipine tocolysis was proven to be more effective than nifedipine only. Although salbutamol + nifedipine had increased temporary side effects, most were nonsevere and managed in-flight.
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Affiliation(s)
- Breeanna Spring Walsh
- Royal Flying Doctor Service of Australia, Barton, Canberra, Australia; School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australia.
| | - Fergus W Gardiner
- Royal Flying Doctor Service of Australia, Barton, Canberra, Australia; The Rural Clinical School of Western Australia, The University of Western Australia, Crawley, Western Australia, Australia
| | - Dianne Bloxsome
- School of Nursing and Midwifery, Edith Cowan University, Joondalup, Western Australia, Australia
| | - David Ford
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australia
| | - Brennen W Mills
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australia
| | - Simon M Laws
- School of Medical and Health Sciences, Edith Cowan University, Joondalup, Western Australia, Australia; Centre for Precision Health, Edith Cowan University, Joondalup, Western Australia, Australia
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Ovaskainen K, Ojala R, Gissler M, Luukkaala T, Tammela O. Is birth out-of-hospital associated with mortality and morbidity by seven years of age? PLoS One 2021; 16:e0250163. [PMID: 33882082 PMCID: PMC8059817 DOI: 10.1371/journal.pone.0250163] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 03/31/2021] [Indexed: 11/19/2022] Open
Abstract
Background and aims Compared to in-hospital births, the long-term outcome of children born out-of-hospital, planned or unplanned, is poorly studied. This study aimed to examine mortality and morbidity by seven years of age in children born out-of-hospital compared to those born in-hospital. Methods This study was registered retrospectively and included 790 136 children born in Finland between 1996 and 2013. The study population was divided into three groups according to birth site: in-hospital (n = 788 622), planned out-of-hospital (n = 176), and unplanned out-of-hospital (n = 1338). Data regarding deaths, hospital visits, reimbursement of medical expenses, and disability allowances was collected up to seven years of age or by the year-end of 2018. The association between birth site and childhood morbidity was determined using multivariable-adjusted Cox hazard regression analysis. Results No deaths were reported during the first seven years after birth in the children born out-of-hospital. The percentage of children with hospital visits due to infection by seven years of age was lower in those born planned out-of-hospital and in the combined planned out-of-hospital and unplanned out-of-hospital group compared to those born in-hospital. Furthermore, the percentage of children with hospital visits and who received disability allowances due to neurological or mental disorders was higher among those born unplanned out-of-hospital and out-of-hospital in total when compared to those born in-hospital. In the multivariable-adjusted Cox proportional hazard regression analysis, the hazard ratio for hospital visits due to asthma and/or allergic diseases (HR 0.84; 95% CI 0.72–0.98) was lower in children born out-of-hospital when compared to those born in-hospital. A similar decreased risk was found due to infections (HR 0.76; 95% CI 0.68–0.84). However, the risk for neurological or mental health disorders was similar between the children born in-hospital and out-of-hospital. Conclusions Morbidity related to asthma or allergic diseases and infections by seven years of age appeared to be lower in children born out-of-hospital. Birth out-of-hospital seemed to not be associated with increased risk for neurological morbidity nor early childhood mortality. Our study groups were small and heterogeneous and because of this the results need to be interpreted with caution.
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Affiliation(s)
- Katja Ovaskainen
- Department of Pediatrics, Tampere University Hospital, Tampere, Finland
- School of Medicine Doctoral Programme, University of Tampere, Tampere, Finland
- * E-mail:
| | - Riitta Ojala
- Department of Pediatrics, Tampere University Hospital, Tampere, Finland
- Center for Child Health Research, Tampere University and University Hospital, Tampere, Finland
| | - Mika Gissler
- Finnish Institute for Health and Welfare, Helsinki, Finland
- Karolinska Institutet, Stockholm, Sweden
| | - Tiina Luukkaala
- Tampere University Hospital, Research, Development and Innovation Center, Tampere, Finland
- Tampere University, Faculty of Social Sciences, Health Sciences, Tampere, Finland
| | - Outi Tammela
- Department of Pediatrics, Tampere University Hospital, Tampere, Finland
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Ovaskainen K, Ojala R, Tihtonen K, Gissler M, Luukkaala T, Tammela O. Unplanned out-of-hospital deliveries in Finland: A national register study on incidence, characteristics and maternal and infant outcomes. Acta Obstet Gynecol Scand 2020; 99:1691-1699. [PMID: 32609879 DOI: 10.1111/aogs.13947] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/26/2020] [Revised: 06/17/2020] [Accepted: 06/20/2020] [Indexed: 11/27/2022]
Abstract
INTRODUCTION Unplanned out-of-hospital deliveries (UOHDs) have earlier been related to higher perinatal mortality and morbidity, but recent research has not paid much attention to them. Our aim was to evaluate the incidence, characteristics, risk factors, and maternal and perinatal mortality and morbidity in UOHDs in Finland. MATERIAL AND METHODS We conducted a national register study on births, causes of death and congenital anomalies for all live and stillbirths during 1996-2013. The study group included 1420 infants delivered by mothers with UOHDs. The 1 051 139 infants born in hospitals during the study period were the reference group. Data on maternal and delivery characteristics, obstetric procedures, infants' characteristics, neonatal care unit admissions, diagnoses, congenital anomalies and causes of death were collected. RESULTS The annual rate of UOHDs increased in 1996-2013 from 46 to 260 per 100 000 deliveries, whereas the number of delivery units decreased from 44 to 29. UOHD infants had five times higher perinatal mortality rates than those delivered in hospitals. The perinatal mortality rate did not change by time in the UOHDs, whereas it diminished among in-hospital deliveries. Maternal morbidity in UOHDs was low. The predictors for UOHDs were delivery after the year 2001, delivery in sparsely populated areas, alcohol, drug abuse and/or smoking during pregnancy, being single, fewer prenatal visits, having delivered earlier and birthweight <2500 g. UOHD was one of the predictors of perinatal morbidity and mortality. Among the UOHD cases, the predictors of perinatal morbidity or mortality included low birthweight and preterm delivery. Time period seemed not to predict morbidity or mortality. CONCLUSIONS The UOHD rate increased, probably due to multifactorial causes, including living in area with low population density and short duration of labor. UOHD was a significant predictor of perinatal morbidity or mortality, but the numbers were very small. Neonatal morbidity and mortality in UOHDs did not seem to be related to the area or time period of birth.
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Affiliation(s)
- Katja Ovaskainen
- Department of Pediatrics, Tampere University Hospital, Tampere, Finland.,School of Medicine Doctoral Program, University of Tampere, Tampere, Finland
| | - Riitta Ojala
- Department of Pediatrics, Tampere University Hospital, Tampere, Finland
| | - Kati Tihtonen
- Department of Obstetrics and Gynecology, Tampere University Hospital, Tampere, Finland
| | - Mika Gissler
- Finnish Institute for Health and Welfare, Helsinki, Finland.,Karolinska Institutet, Stockholm, Sweden
| | - Tiina Luukkaala
- Research, Development and Innovation Center, Tampere University Hospital, Tampere, Finland.,Faculty of Social Sciences, Health Sciences, Tampere University, Tampere, Finland
| | - Outi Tammela
- Department of Pediatrics, Tampere University Hospital, Tampere, Finland
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Combier E, Roussot A, Chabernaud JL, Cottenet J, Rozenberg P, Quantin C. Out-of-maternity deliveries in France: A nationwide population-based study. PLoS One 2020; 15:e0228785. [PMID: 32092074 PMCID: PMC7039464 DOI: 10.1371/journal.pone.0228785] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2019] [Accepted: 01/22/2020] [Indexed: 11/19/2022] Open
Abstract
Introduction In France, many maternity hospitals have been closed as a result of hospital restructuring in an effort to reduce costs through economies of scale. These closures have naturally increased the distance between home and the closest maternity ward for women throughout the country. However, studies have shown a positive correlation between this increase in distance and the incidence of unplanned out-of-maternity deliveries (OMD). This study was conducted to estimate the frequency of OMD in France, to identify the main risk factors and to assess their impact on maternal mortality and neonatal morbidity and mortality. Materials and methods We conducted a population-based observational retrospective study using data from 2012 to 2014 obtained from the French hospital discharge database. We included 2,256,797 deliveries and 1,999,453 singleton newborns in mainland France, among which, 6,733 (3.0‰) were OMD. The adverse outcomes were maternal mortality in hospital or during transport, stillbirth, neonatal mortality, neonatal hospitalizations, and newborn hypothermia and polycythemia. The socio-residential environment was also included in the regression analysis. Maternal and newborn adverse outcomes associated with OMD were analyzed with Generalized Estimating Equations regressions. Results The distance to the nearest maternity unit was the main factor for OMD. OMD were associated with maternal death (aRR 6.5 [1.6–26.3]) and all of the neonatal adverse outcomes: stillbirth (3.3 [2.8–3.8]), neonatal death (1.9 [1.2–3.1]), neonatal hospitalization (1.2 [1.1–1.3]), newborn hypothermia (5.9 [5.2–6.6]) and newborn polycythemia (4.8 [3.5–6.4]). Discussion In France, OMD increased over the study period. OMD were associated with all the adverse outcomes studied for mothers and newborns. Caregivers, including emergency teams, need to be better prepared for the management these at-risk cases. Furthermore, the increase in adverse outcomes, and the additional generated costs, should be considered carefully by the relevant authorities before any decisions are made to close or merge existing maternity units.
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Affiliation(s)
- Evelyne Combier
- Biostatistics and Bioinformatics (DIM), Inserm, France University Hospital, Bourgogne Franche-Comté University, Dijon, France
| | - Adrien Roussot
- Biostatistics and Bioinformatics (DIM), Inserm, France University Hospital, Bourgogne Franche-Comté University, Dijon, France
| | - Jean-Louis Chabernaud
- Neonatal and Pediatric Emergency Transport Team and NICU, Antoine-Beclere Hospital, AP-HP, Paris Saclay University, Clamart, France
| | - Jonathan Cottenet
- Biostatistics and Bioinformatics (DIM), Inserm, France University Hospital, Bourgogne Franche-Comté University, Dijon, France
| | - Patrick Rozenberg
- Versailles Saint-Quentin University, Department of Obstetrics and Gynecology, Poissy-Saint Germain Hospital, Poissy, France
| | - Catherine Quantin
- Biostatistics and Bioinformatics (DIM), Inserm, France University Hospital, Bourgogne Franche-Comté University, Dijon, France
- Biostatistics, Biomathematics, Pharmacoepidemiology and Infectious Diseases (B2PHI), INSERM, UVSQ, Institut Pasteur, Université Paris-Saclay, Paris, France
- * E-mail:
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Vagle H, Haukeland GT, Dahl B, Aasheim V, Vik ES. Emergency medical technicians' experiences with unplanned births outside institutions: A qualitative interview study. Nurs Open 2019; 6:1542-1550. [PMID: 31660182 PMCID: PMC6805291 DOI: 10.1002/nop2.354] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2019] [Revised: 07/03/2019] [Accepted: 07/15/2019] [Indexed: 01/23/2023] Open
Abstract
AIM To explore emergency medical technicians' experiences with unplanned births outside institutions. DESIGN A qualitative interview study. METHODS Individual semi-structured interviews with 12 emergency medical technicians in Norway. Systematic text condensation was used to analyse the data material. RESULTS Analysis showed that there is a mismatch between society's expectations about emergency medical technicians and the reality they encounter in out-of-hospital maternity care, that emergency medical technicians experience a general lack of training in caring for labouring women and that poor communication with other health professions challenges patient safety. The participants expressed how they do their best in caring for both mother and child, in spite of a lack of education, training and competence in assisting labouring women.
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Affiliation(s)
- Hanne Vagle
- Faculty of Health and Social SciencesWestern Norway University of Applied SciencesBergenNorway
| | - Gunn Terese Haukeland
- Faculty of Health and Social SciencesWestern Norway University of Applied SciencesBergenNorway
| | - Bente Dahl
- Centre for Women's, Family and Child Health, Faculty of Health and Social SciencesUniversity of South‐Eastern NorwayKongsbergNorway
| | - Vigdis Aasheim
- Faculty of Health and Social SciencesWestern Norway University of Applied SciencesBergenNorway
| | - Eline Skirnisdottir Vik
- Faculty of Health and Social SciencesWestern Norway University of Applied SciencesBergenNorway
- Department of Global Public Health and Primary CareUniversity of BergenBergenNorway
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Diana L, Glaucia L, Adriana C, Israel F. Out-of-hospital deliveries: A case-control study. Turk Arch Pediatr 2018; 53:87-95. [PMID: 30116129 DOI: 10.5152/turkpediatriars.2018.6269] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2017] [Accepted: 03/09/2018] [Indexed: 11/22/2022]
Abstract
Aim To identify the factors, risks, and mortality associated with unplanned out-of-hospital births. Material and Methods This observational, retrospective, case-control study was conducted between 2005 and 2013 through a review of medical records from the hospital network of a county of Brazil. Mother-child dyads were divided into in-hospital births and unplanned out-of-hospital births. For hypothesis testing involving quantitative variables, parametric and nonparametric methods (t-test or Mann-Whitney test, respectively) were used as appropriate after ascertaining normality of distribution via the Kolmogorov-Smirnov or Shapiro-Wilk tests. The chi-square test, Fisher's exact test, odds ratios, and 95% confidence intervals were used to assess the relationship between categorical variables. A binary logistic regression was applied for pooled analysis of those variables that, when analyzed in isolation, had significant p-values on hypothesis testing. In all tests, p-values <0.05 were considered statistically significant. Results Of the 420 records, 117 corresponded to out-of-hospital births dyads. Mothers were predominantly nonwhite (p<0.001), with a history of inadequate antenatal care (p<0.001), multiparous (p<0.001), aged >25 years (p=0.031), and had more puerperal complications (p<0.001). Their newborns had low birth weight (Odds Ratios: 2.22; 95% CI: [1.4-3.4]; p<0.001), higher morbidity (p=0.009), a higher rate of admission to neonatal intensive care and stepdown units (p=0.030), and prolonged length of stay (p<0.001). Conclusion The risk of maternal and neonatal complications, as well as the neonatal mortality rate, were higher for unplanned out-of-hospital deliveries. It occurred predominantly in nonwhite, older, multiparous women who had received incomplete antenatal care and who lived far from perinatal care centers.
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Affiliation(s)
- Lima Diana
- Department of Materal and Child, Federal Fluminense University, Niterói, RJ, Brazil
| | - Lima Glaucia
- Department of Materal and Child, Federal Fluminense University, Niterói, RJ, Brazil
| | - Cersosimo Adriana
- Department of Materal and Child, Federal Fluminense University, Niterói, RJ, Brazil
| | - Figueiredo Israel
- Department of Materal and Child, Federal Fluminense University, Niterói, RJ, Brazil
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Thornton CE, Dahlen HG. Born before arrival in NSW, Australia (2000-2011): a linked population data study of incidence, location, associated factors and maternal and neonatal outcomes. BMJ Open 2018; 8:e019328. [PMID: 29540412 PMCID: PMC5857678 DOI: 10.1136/bmjopen-2017-019328] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVES To determine incidence, associated factors, outcomes and geographical occurrence of born before arrival (BBA) in New South Wales, Australia. DESIGN A linked population data study involving population-based surveillance systems was undertaken for the years 2000-2011. SETTING New South Wales, Australia. PARTICIPANTS All women who underwent BBA compared with women who birthed in hospital/birth centre settings. RESULTS During the time period, there were 1 097 653 births and a BBA rate of 4.6 per 1000 births. The BBA rate changed from 4.2 to 4.8 per 1000 births over time (p=0.06). Neonates BBA were more likely to be premature (12.5% compared with 7.3%), of lower birth weight (209.8 g mean difference) and/or be admitted to a special care nursery or neonatal intensive care unit (20.6% compared with 15.6%). The perinatal mortality rate was significantly higher in the BBA cohort (34.6 compared with 9.3 per 1000 births). Women in the BBA cohort were more likely to be in the lowest socioeconomic decile, multiparous, have higher rates of smoking (30.5% compared with 13.8%) and more likely to suffer a postpartum haemorrhage requiring transfusion than the non-BBA cohort (1.5% compared with 0.7%). The most commonly occurring complications for neonates were suspected infection (6.9%), hypothermia (6.9%), respiratory distress (5.4%), congenital abnormality (4.0%) and neonatal withdrawal symptoms (2.4%). BBA more commonly occurred in geographical areas where the distance to a maternity unit is >2 hours drive and in coastal regions where there is also a high rate of homebirth. CONCLUSION BBA occurs more frequently in multiparous women of lower socioeconomic status. There potentially is an effect of geography on the occurrence of BBA, as geographical area of high homebirth and BBA coexists, indicating that freebirth followed by an unplanned transfer to hospital may be occurring.
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Affiliation(s)
- Charlene Eliza Thornton
- School of Nursing and Midwifery, Western Sydney University, Penrith South, New South Wales, Australia
- College of Nursing and Health Sciences, Flinders University, Adelaide, South Australia, Australia
| | - Hannah Grace Dahlen
- School of Nursing and Midwifery, Western Sydney University, Penrith South, New South Wales, Australia
- Ingham Institute, Liverpool, New South Wales, Australia
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