Outcome of Unattended Out-of-Hospital Births in Harlem

OBJECTIVE: To determine the maternal risk factors and infant outcome for unattended out-of-hospital deliveries brought to an inner-city public hospital. METHODS: We compared 59 infants born alive out of hospital during 1989 with 151 randomly selected in-hospital live births, all with birth weight greater than 500 g. RESULTS: History of cocaine use during pregnancy (odds ratio [OR], 4.20; 95% confidence interval [CI], 1.68 to 10.5) and lack of Medicaid or other health insurance (OR, 2.15; 95% CI, 1.04 to 4.45) were independently associated with out-of-hospital delivery. Out-of-hospital delivery was associated with hypothermia (defined as admission axillary temperature < 35 degrees C; OR, 20.8; 95% CI, 4.81 to 89.9) and with hypoglycemia (defined as admission glucose reagent strip reading < 2.2 mmol/L [< 40 mg/dL]; OR, 4.41; 95% CI, 1.29 to 15.1) in separate analyses controlling for birth weight and other risk factors. Polycythemia (venous or arterial hematocrit > 0.65 at age > or = 6 hours) occurred in 14% (eight of 59) of out-of-hospital births. The increased neonatal mortality rate for infants born out of hospital (20.3 vs 7.3 per 1000 live births; OR, 2.82; 95% CI, 1.23 to 6.47) was due to an excess of infants weighing 500 to 999 g. CONCLUSIONS: Unattended out-of-hospital births result in increased neonatal morbidity that may be partly preventable by simple interventions used routinely at inhospital deliveries.