sarah hargand, mph research analyst center for health statistics oregon health authority oregon’s...
TRANSCRIPT
Sarah Hargand, MPHResearch AnalystCenter for Health StatisticsOregon Health Authority
Oregon’s HB 2380 Gathering data on planned
place of birth
The 2011 Oregon legislature passed House Bill 2380 that required the Center for Health Statistics to gather new information on planned place of birth for both live births and fetal deaths and report on outcomes.
Two new questions are added to the birth and fetal death certificates.
HB 2380
Background
2011 Legislative Session
Out-of-Hospital Births in Oregon
Midwives
Implementation
Training
Quality Assurance
Analysis
Preliminary Report
Special Perinatal Case Fatality Report
Overview
HB 2380 is introduced
Public hearings and work sessions
HB 2380 is amended.
2011 Legislative Session
HB2380
“The Center for Health Statistics shall collect and report data on birth and fetal death outcomes occurring in this state, including intrapartum and neonatal transfers to hospital care from another birthing facility, hospital or other location. The center shall report the data by attendant type. The report shall distinguish outcomes between licensed direct entry midwives and direct entry midwives who are not licensed under ORS 687.405 to 687.495.”
Out-of-Hospital Births
2008 2009 2010 20110
0.5
1
1.5
2
2.5
3
3.5
4
2.9 2.9
3.43.7
1.0 1.1 1.2
Oregon U.S.
U.S. rate not
available
Oregon Births Occurring Out-of-Hospital, 2011
Planned Homebirth
58.1%
Freestanding Birth Center
35.8%
Other6.1%
In the State of Oregon, a midwife does not need a license to practice midwifery.
The Oregon Center for Health Statistics collects data on three different types of midwives.
Midwives
Attendant TypePercent of Births, 2011Hospital
BirthsPlanned
OOH BirthsCertified Nurse Midwives (CNM) 17% 16%Licensed Direct Entry Midwives (LDM) 0% 62%Unlicensed Midwives 0% 7%
Implementation
Two new questions are added to the birth and fetal death certificates effective January 1, 2012.
1) Did mother go into labor planning to deliver at home or at a freestanding birthing center?
2) If yes, the planned primary attendant type at onset of labor was:
ImplementationJuly
2011: HB2380
is passed
Aug. 2011: Work
order to vendor
Sept. 2011: Contact
stakeholders
Oct. 2011: Newsletter
to birth clerks
Nov. 2011: Birth & Fetal worksheets
updated, webinar created
Dec. 2011: Database structure updated
Jan. 2012: Questions
go live
Implementation
Total Cost: $38,757.25
Total Staff Time: $26,257.25Hours: 682.5
Vendor Costs: $12,500.00Hours: 85
Quality Assurance
Quality assurance started in February and included:
1) Response rate
2) Verification of planned out-of-hospital birth
3) Verification of attendant type
Preliminary Report
Jan. 1, 2012- Sept. 30, 2012 Oregon Occurrence Births
Place of Birth Total Term Births
Neonatal Deaths
State Total 31,883 29Hospital Births 30,330 24Planned Out-of-Hospital Births 1,493 5
Born in Hospital 320 4
Other 60 0
Special Report: Maternal Characteristics
Maternal Characteristics, 2012 Births Hospital Planned OOH
Mother's Age 30+ 43% 57%
White, non-Hispanic 68% 87%
Married 64% 83%
College Educated 29% 46%
Self-pay 1% 28%
Special Report: Medical & Health Characteristics
Medical & Health Characteristics, 2012 Births Hospital Planned OOH
No Prenatal Care 0.4% 3%
First Trimester care 77% 64%
Overweight/Obese 49% 32%
Tobacco 11% 2%
For 2012, the Oregon Public Health Division conducted a special study involving a perinatal fatality case review of term births intended to occur out-of-hospital.
• 1,995/41,979 (4.8%) planned an out-of-hospital birth
• 381 of 1,995 (19.1%) planned out-of-hospital births ultimately delivered in-hospital
Special Perinatal Fatality Case Review
Special Perinatal Fatality Case Review
• 9 (9.7%) term fetal and neonatal deaths occurred among planned out-of-hospital births
• 7 of 9 transferred to the hospital during labor
• These 9 deaths underwent a fetal and neonatal mortality case review per published national guidelines
Special Perinatal Fatality Case Review
6 of 9 pregnancies did not meet published low-risk criteria for out-of-hospital birth:
• More than 41 weeks gestation (4);• Twin gestation (2);• Untreated Group B streptococcus vaginal
colonization (2);• Morbid obesity (>40 BMI) (1);
What’s Next?
Genevieve Buser, MD, MSHPEIS Fellow, Oregon Public Health Division
Anna Stiefvater, RN, MPHPerinatal Nurse Consultant, Maternal and Child Health
Katrina Hedberg, MD, MPHState Epidemiologist and Chief Science Officer
Contact:
Sarah Hargand, [email protected]
Acknowledgments and Contact