Unplanned, out-of-hospital births result in higher infant mortality in Norway, according to new research published in the Acta Obstetricia et Gynecologica Scandinavica, a journal of the Nordic Federation of Societies of Obstetrics and Gynecology. The study states that multiparous women or young women who have given birth at least once before and those living in remote areas are most susceptible to having unplanned deliveries, which may increase the risk of death in newborns.

The number of institutions with birthing centers has reduced over the years in Norway. From 158 centers in 1972, there are just 51 now. While these are better equipped to handle medical emergencies and perinatal mortality rates have come down from 22 out of 1,000 births (1967-1971) to just five in 2010, the reduced number of birthing centers means more number of unplanned deliveries.

According to Statistics Norway, close to 60,000 babies were born in 2013. And the reduced number of birthing centers means that many were born outside the hospital. Medical evidence suggests that unplanned births in Norway have increased from four per 1,000 births in 1979-83 to seven in 1,000 births over the past few years.

"This trend to centralize obstetrics has improved perinatal mortality rates," explained lead author Dr. Björn Gunnarsson from the Norwegian Air Ambulance Foundation in Drøbak, Norway, in a statement. "One downside to specialized care in central locations is an increase in unplanned births and its adverse outcomes, which is the focus of our study."

The researchers collected data from the Medical Birth Registry of Norway from 1999 to 2013.This registry has a record of all the births, including those that happened outside the hospital. Data for such births are submitted by the physician or midwife present during or after the birth. During this period, there were 4,899 unplanned births and these were compared with a reference group that comprised of all other births.

The study found that since 1999, seven per 1,000 deliveries were unplanned births that take place outside the hospital. The risk of unplanned deliveries is more in young multiparous women living in remote areas that don’t have immediate access to birthing centers. A surprising find is that young multiparous women giving birth have a 20 times greater risk of unplanned birth compared to older women who have never given birth (nullipara).

Also, during this research period, the number of perinatal death was 11 per 1,000 births in the unplanned group compared to seven per 1,000 in the reference group. The babies most at risk were ones with low birth weight (500-999 grams; 1-2 pounds) in the unplanned group.

The annual infant mortality rate was more or less the same during the study period but did decline an average of three percent each year for the reference group.

"Our findings suggest that unplanned births are linked to greater risk of perinatal mortality, which may be caused by limited access to proper medical care for vulnerable newborns. Further study of additional morbidities and potential interventions that reduce unplanned births is needed,” Gunnarsson said.

Source: Gunnarsson B, Smárason A, Skogvoll E, Fasting S. Characteristics and Outcome of Unplanned Births Out-Of-Institutions in Norway From 1999 To 2013: A Cross-Sectional Study. Acta Obstetricia et Gynecologica Scandinavica. 2014.