Office-hours versus off-hours deliveries among low-risk singleton pregnancies in Türkiye and early maternal and neonatal adverse outcomes: A retrospective cohort study

Background The timing of birth may influence the quality and safety of obstetric care due to differences in staffing, workload, and clinical support. This study examined the association between office-hours and off-hours deliveries and early maternal and neonatal adverse outcomes. Methods This retrospective cohort study was conducted at a maternity hospital in Kahramanmaraş, Türkiye. Deliveries occurring between January 1, 2022, and January 1, 2023 were reviewed retrospectively. Births were classified as office-hours (08:00–15:59, Monday–Friday) or off-hours (16:00–07:59 on weekdays and all hours on weekends). Maternal and neonatal outcomes were compared between the groups using appropriate statistical tests, and odds ratios (ORs) with 95% confidence intervals (CIs) were calculated. Results A total of 1000 mother-newborn dyads were included, with 500 births occurring during office-hours and 500 during off-hours. Off-hours deliveries were associated with higher odds of intrapartum cesarean section (OR 2.27; 95% CI 1.02–5.04; p = 0.038) and episiotomy (OR 2.19; 95% CI 1.57–3.04; p < 0.001). Birth trauma was significantly less likely among births occurring during office-hours than among those occurring during off-hours (OR 0.28; 95% CI 0.09–0.85; p = 0.029). No significant differences were observed between the groups in postpartum haemorrhage, need for blood transfusion, or maternal death. Similarly, neonatal outcomes including low Apgar score at 5 min, respiratory distress, need for resuscitation, and admission to neonatal care did not differ significantly between the groups. Conclusions Births occurring during off-hours were associated with higher rates of intrapartum cesarean section, episiotomy, and birth trauma. These findings highlight the importance of ensuring consistent quality of obstetric care across all hours of service.