Hospital Birth Research Articles

The Impact of Comprehensive Fetal Care on Mortality of Children With Congenital Diaphragmatic Hernia when Delivery is Co-located in a Pediatric Hospital

BackgroundWe evaluated the impact of delivery at a comprehensive fetal care center co-located in a pediatric hospital on extracorporeal membrane oxygenation (ECMO) exposure and survivorship of children with CDH. MethodsThis retrospective study includes maternal–fetal dyads with a prenatal diagnosis of isolated CDH who received any prenatal care at a single fetal center between February 2006 and March 2021. The principal variables included: (1) delivery setting (children born in the pediatric hospital [“inborn”] vs. children who were delivered elsewhere [“outborn”]), (2) exposure to ECMO (yes vs. no), and (3) survival-at-discharge from birth hospitalization (yes vs. no). Multivariable logistic regression was used to evaluate the association between delivery setting and ECMO cannulation, and whether delivery setting moderates the association between exposure to ECMO and survival-at-discharge. ResultsAmong 418 maternal–fetal dyads, 77.0% of children were inborn and 32.0% of children were exposed to ECMO during their index hospitalization. Inborn children had more severe prenatal prognostic indicators but had a 57% lower odds of extracorporeal than outborn children. In multivariable logistic regression, delivery setting moderated the association between exposure to ECMO and survival-at-discharge. Although there was no statistically significant difference in mortality between inborn and outborn children who were not exposed to ECMO, inborn children exposed to ECMO had a 6.86 (1.98, 23.74) increased odds of death and outborn children exposed to ECMO had a 17.71 (4.69, 66.87) increased odds of death when both were compared to non-cannulated outborn children. ConclusionsComprehensive fetal care with delivery co-located in a pediatric hospital was associated with decreased exposure to ECMO and a survivorship advantage among children with CDH who required extracorporeal support. Level of EvidenceLevel III.

Critical diseases in neonates after discharge home from birth hospital: A retrospective study from a tertiary hospital in Japan

IntroductionTo establish actionable neonatal screening during the first month of life, we investigated critical diseases in seemingly healthy newborns discharged from birth hospitals. MethodsThis retrospective study enrolled previously healthy full-term infants who visited our hospital, a tertiary hospital in Japan, from home between 5 and 28 days after birth from 2009 to 2018. Infants with known perinatal or congenital diseases, positive newborn screening results, or accidental injuries were excluded. Data were collected from electronic medical records, including principal diagnosis, clinical details, and prognosis at 18 months of age. ResultsNinety-seven (58 %) of 168 eligible neonates were admitted to the hospital, and 71 (42 %) were not. The median admission rate in patients with disease onset at ≤14 days after birth (80 %) was significantly higher than that in patients with disease onset at ≥15 days (42 %). Among 45 patients who received intensive medical care, 5 died and 10 developed neurodevelopmental sequelae. Four of 5 patients died by 100 days. Among 25 diseases treated in intensive care unit, 17 (68 %) diseases had a prevalence of <1 per 2000 live births. The commonly used diagnostic methods were imaging (n = 58, 35 %) and physical examination (n = 34, 20 %). ConclusionCritical diseases due to rare and heterogeneous causes in ostensibly healthy newborns occurred predominantly in the first two weeks of life. Optimal newborn screening and health check-up protocols may benefit from the wide spectrum of life-threatening diseases occurring in home after birth.

Implementation of Vikor Algorithm in Web-Based Recommendation System for Obstetrician Selection

The process of childbirth is a natural event for women; with the increase in birth rates, selecting a suitable obstetrician becomes essential. However, many couples find it challenging to choose the right obstetrician, from consultations to hospital births. This study aims to develop an obstetrician recommendation system to overcome decision-making challenges that involve many criteria. The method used is VIseKriterijumska Optimizacija Kompromisno Resenje (VIKOR), which is one of the best methods in Multiple Criteria Decision Making (MCDM) for ranking and selecting alternatives. This method involves several steps, including determining the weight of the criteria, normalizing the matrix, calculating the Utility Measure and Regret Measure, and calculating the VIKOR index. Testing was carried out through scenario tests and user survey tests using the USE questionnaire. The scenario test results show the successful implementation of VIKOR in this system. The results of the user survey test indicated a high level of satisfaction with a score of 83.34%, which fulfilled the four variables in the USE questionnaire: usability (79.76%), ease of use (84.81%), ease of learning (84.81), and satisfaction (83.31%). The results of this study have important implications for increasing the effectiveness of decision-making in selecting the right obstetrician. By incorporating the VIKOR method into an application, this research provides a valuable contribution to developing a VIKOR-based recommendation system. It emphasizes the importance of applying this method in complex decision-making environments.

The role of the infectious factor in the genesis of perinatal losses in pregnant women who have birth in maternity hospitals in St. Petersburg and Leningrad Region in 2009–2018

BACKGROUND: One of the tasks of modern medicine is to reduce the level of perinatal losses, for which it is necessary to know their main causes.&#x0D; AIM: To determine the course of an infectious disease in the genesis of perinatal losses.&#x0D; MATERIALS AND METHODS: In order to determine the role of infection in the genesis of perinatal losses, a retrospective study was conducted with two groups: the main group 307 women with perinatal fetal death, the control group 357 women without perinatal losses. An analysis was also made of the data of the statistical form No. 32 (annual) Information on medical care for pregnant women, women in childbirth and puerperas, presented by the Medical Information and Analytical Centers of St. Petersburg and the Leningrad Region for 20062018 and annual reports of the Leningrad Regional Pathological Anatomical Bureau for 20062016.&#x0D; RESULTS: In 20062018, the leading causes of perinatal death were intrauterine hypoxia and asphyxia during childbirth (ICD 10: P20, P21), that is, not diseases, but symptomatic conditions. Such features of reporting documentation complicate the analysis of the causes of perinatal losses and the implementation of a set of preventive measures, including at the state level. Also, according to the official report, it is impossible to assess the contribution of a specific virus and a specific localization of the lesion to the genesis of perinatal losses. In the main group, hematogenous viral and ascending bacterial infection of the placenta was detected 4 times more often. With a combination of bacterial and viral infection of the placenta, the risk of a fatal outcome increases. Infectious pathogens most frequently encountered in perinatal losses have been established.&#x0D; CONCLUSIONS: The cause of more than half of the cases of perinatal losses in women who gave birth in maternity hospitals in St. Petersburg and Leningrad Region in 20092018 is an infectious pathology: viral, bacterial and viral-bacterial, and not intrauterine hypoxia/asphyxia during childbirth, as stated by the official statistics. In this regard, the main direction in the prevention of perinatal losses is the timely detection and treatment of infectious pathology.

Prevalence of congenital anomalies and related factors in live births in Zahedan, Southeast of Iran: A cross-sectional study.

The term congenital anomalies (CAs) refers to structural or functional abnormalities at the time of conception. Approximately 12 deaths related to congenital disabilities occur in every 10,000 babies born. This study aimed to evaluate the prevalence and associated factors of single and multiple CAs in live births in Zahedan, Southeast Iran. This cross-sectional study was conducted on 59,087 live births in a referral hospital in Zahedan located in the southeast of Iran from 2009 to 2019. All live births were examined by pediatricians and the CAs and categorized based on the international classification of diseases. Of 59,085 live births, at least 883 had a significant anomaly, and the prevalence rate of CAs was about 149 per 10,000. Anomalies of the nervous (24.1%) and cardiovascular systems (21.10%) were the most frequent, occurring in 213 and 187 of the live births, respectively. Spina bifida is the most common anomaly of the central nervous system. The most common anomalies in the cardiovascular system were unspecified heart malformations (17.1%), cardiovascular malformations (18.7%), and patent ductus arteriosus (11.7%). Significant correlations were found between the parent's consanguinity marriage, the mother's age, an existing anomaly in the family, and relatives in single and multiple CAs (p = 0.02, p = 0.02, p 0.001, p = 0.01, respectively). The prevalence of CAs was 149 per 10,000 live births. The highest prevalence of CAs was related to the central nervous system. Increasing the public's knowledge about fetal defects can reduce the prevalence of CAs.

Maternal disability and newborn discharge to child protection in Ontario, Canada

ObjectivesOne in 8 pregnancies are to women with disabilities. These mothers can face additional social, structural, and health-related challenges, and negative health care provider assumptions about their parenting capacity. We aimed to examine rates of newborn discharge to child protection comparing newborns of mothers with and without a disability.&#x0D; MethodWe are conducting a population-based cohort study in Ontario, Canada using linked administrative health data. The cohort includes all women in Ontario with a live birth between 2003 and 2020. Diagnostic algorithms were applied to health care encounters prior to pregnancy to identify maternal disability. We will use modified Poisson regression to estimate the relative risk of discharge to child protection immediately after the birth hospital stay, comparing newborns of women with physical, sensory, developmental, and multiple disabilities to those without disabilities. Models will be adjusted for socio-demographic factors, antenatal care receipt, and maternal mental illness and substance use disorders.&#x0D; ResultsThe study cohort includes of over 1.4 million newborns delivered to women with physical disabilities (n=120,014), sensory disabilities (n=39,892), developmental disabilities (n=2,182), multiple disabilities (n=8,428), and no known disability (n=1,269,633). Analyses are ongoing and results will be concluded by the conference date.&#x0D; ConclusionEarly infancy is a critical period for breastfeeding and maternal-infant bonding. Findings will inform the development of tailored services and resources for supporting women with disabilities in antenatal care and after birth by identifying those most at-risk of child protection intervention, thus potentially reducing maternal-newborn separations.

The effect of uterine massage after vaginal delivery on the duration of placental delivery and amount of postpartum hemorrhage.

The aim of this study was to investigate the effects of uterine massage performed before placental delivery on the third stage of labor and postpartum hemorrhage after vaginal delivery. The study was designed as a prospective randomized controlled study. Between June 2018 and June 2019, 242 women who gave birth in Istanbul Kanuni Sultan Suleyman Training and Research Hospital were included in the study. The women were divided into two groups; group 1 received uterine massage after vaginal delivery before placental delivery (n: 128) and group 2 did not receive massage (n: 114). Demographic characteristics, delivery times of the baby and placenta, duration of uterine massage, amount of postpartum hemorrhage and postpartum hemoglobin values of both groups were recorded. Baseline characteristics were similar in both groups. Placental output time after delivery was 8.3 ± 4.2min in group 1 and 13.5 ± 6.3min in group 2. The third stage of labor was significantly shorter in group 1 (p = 0.012). The amount of blood loss of 500mL or more after delivery was higher in group 2 but not statistically different (p > 0.05). Hemoglobin value measured within 12-24h after delivery was significantly lower in group 2 (hemoglobin < 8g/dL after 12-24h p = 0.003; hemoglobin < 10g/dL after 12-24h p = 0.001). Delta hb value was also significantly lower in group 2 (p = 0.03). With this result, it was determined that bleeding intense enough to require transfusion was more common in group 2. In patients delivering vaginally, uterine massage before placental delivery shortens the placental delivery time and reduces postpartum hemorrhage. In addition to oxytocin and controlled cord traction to reduce postpartum blood loss, uterine massage should be routinely used in the active management of the third stage of labor. NCT03858569.

“Sacred and Beautiful”: The Lived Experience of Slovak Women who had a Planned Homebirth

Abstract While many Western countries do legally permit homebirths under certain conditions, in the Slovak Republic they exist in a legal vacuum – they are neither permitted nor prohibited. In the present study, we aimed to explore how Slovak women who deliberately delivered at home perceive the reason for this decision and the subsequent homebirth itself. We interviewed eight women aged 21 to 36 and analysed the transcripts using the interpretative phenomenological analysis framework. The analysis revealed four major themes – (1) the sacredness of childbirth, (2) the aspiration to be the director of your childbirth, (3) homebirth as an expression of the need for intimacy, and (4) the struggle with one’s social circle. Childbirth is seen as an ultimate act of nature defined by its beauty and purity, but these qualities are tainted by biomedical approach of healthcare providers. The results of this study suggest that women’s needs of autonomy, relatedness, and inclusion are not properly met by Slovak health care and obstetrics. Stricter adherence to the principle of informed consent during hospital births, and legalisation and regulation of homebirths could reduce medical risks during childbirth and improve women’s mental well-being during and after a pivotal moment in their life.

Knowledge of lactation amenorrhea method among postpartum women in Ethiopia: a facility-based cross-sectional study

While the importance of knowledge about contraceptives in improving their utilization and thereby reducing the risk of unintended pregnancies is well documented, there are limited studies documented about the Lactational Amenorrhea Method (LAM). Thus, understanding the knowledge of postpartum mothers about LAM is essential for designing tailored interventions. This study assessed the level of knowledge about LAM and its associated factors among postpartum mothers in Ethiopia. A facility-based cross-sectional study was conducted among 3148 randomly selected postpartum participants. The study utilized multistage sampling approach in hospitals located across five regions and one city administration in Ethiopia. Data were collected using face-to-face interviews at discharge. A participant was categorized as having knowledge of LAM if she correctly answered the three LAM criteria: amenorrhea, the first 6 months, and exclusive breast feeding. A binary logistic regression model was used to identify factors associated with knowledge of LAM. Variables with p < 0.25 in the binary logistic regression were included in the multiple logistic regression. Then, associations were described using the adjusted odds ratio (AOR) along with the 95% confidence interval (CI), and statistical significance was declared at p < 0.05. Only four in 10 participants (40.6%; 95% CI 38.9–42.3) had knowledge of LAM. Participants who attended college or above educational level (AOR = 2.1, 95% CI 1.5–2.8), those with parity of two (AOR = 2.3; 95% CI 1.6–3.6) or more than two (AOR = 2.4; 95% CI 1.5–4.0), those who expressed a desire for further fertility (AOR = 1.3; 95% CI 1.1–1.5), individuals who received counselling on LAM (AOR = 3.0; 95% CI 2.6–3.7), and those who gave birth in hospital (AOR = 2.6; 95% CI 1.4–2.6) had higher odds of knowledge about LAM, compared to their counter parts. In contrary, participants resided far away from health facilities had 30% lower odd of knowledge about LAM compared to those resided near the health facilities (AOR = 0.70; 95% CI 0.6–0.8). The proportion of participants who had knowledge of LAM was low. Strengthening counseling about LAM during antenatal care and delivery with due attention to women with limited access to health facilities should be considered for increasing their level of knowledge on LAM.

Resuscitation, survival and morbidity of extremely preterm infants in California 2011–2019

ObjectiveTo describe changes over time in resuscitation, survival, and morbidity of extremely preterm infants in California.Study designThis population-based, retrospective cohort study includes infants born ≤28 weeks. Linked birth certificates and hospital discharge records were used to evaluate active resuscitation, survival, and morbidity across two epochs (2011–2014, 2015–2019).ResultsOf liveborn infants, 0.6% were born ≤28 weeks. Active resuscitation increased from 16.9% of 22-week infants to 98.1% of 25-week infants and increased over time in 22-, 23-, and 25-week infants (p-value ≤ 0.01). Among resuscitated infants, survival to discharge increased from 33.2% at 22 weeks to 96.1% at 28 weeks. Survival without major morbidity improved over time for 28-week infants (p-value < 0.01).ConclusionAmong infants ≤28 weeks, resuscitation and survival increased with gestational age and morbidity decreased. Over time, active resuscitation of periviable infants and morbidity-free survival of 28-week infants increased. These trends may inform counseling around extremely preterm birth.

Associations between velamentous or marginal cord insertion and risk of adverse perinatal outcomes in twin pregnancies: a retrospective cohort study

BackgroundVelamentous cord insertion (VCI) and marginal cord insertion (MCI) are well-known risk factors for adverse perinatal outcomes in singleton pregnancies. However, the potential links between VCI or MCI and perinatal outcomes in twin pregnancies have yet to be systematically evaluated. This study aimed to investigate the relationships between VCI or MCI and perinatal outcomes in twin pregnancies.MethodsThis retrospective single-center cohort study included women with twin pregnancies who gave birth in a tertiary hospital in Southwest, China between January 2017 and December 2022. VCI and MCI were identified by abdominal ultrasound and confirmed after placental delivery. Logistic regression, multinomial logit regression and generalized estimation equation models were used to evaluate the association between VCI or MCI and perinatal outcomes.ResultsA total of 3682 twin pregnancies were included, including 100 (2.7%) pregnancies with VCI and 149 (4.0%) pregnancies with MCI. Compared to pregnancies with normal cord insertion, both monochorionic and dichorionic pregnancies with VCI were associated with an increased risk of preterm delivery 32–34 weeks (aRRR 2.94, 95% CI 1.03–8.39; aRRR 2.55, 95% CI 1.19–5.46, respectively), while pregnancies with MCI were not associated with preterm delivery. VCI was associated with a higher incidence of placental previa (aOR 6.36, 95% CI 1.92–21.04) in monochorionic pregnancies and placental accreta (aOR 1.85, 95% CI 1.06–3.23) in dichorionic pregnancies. MCI was associated with an increased risk of preeclampsia (aOR 3.07, 95% CI 1.49–6.32), intertwin birthweight discordance ≥ 20% (aOR 2.40, 95% CI 1.08–5.60) and selective fetal growth restriction (aOR 2.46, 95% CI 1.08–5.60) in monochorionic pregnancies and small-for-gestational age neonates (aOR 1.97, 95% CI 1.24–3.14) in dichorionic pregnancies.ConclusionsVCI was associated with an increased risk of preterm delivery in twin pregnancies irrespective of chorionicity, whereas MCI was associated with an increased preeclampsia risk, significant intertwin birthweight discordance in monochorionic pregnancies and small-for-gestational age neonates in dichorionic pregnancies.

Racial and Ethnic Disparities in Anemia and Severe Maternal Morbidity.

To evaluate antepartum anemia prevalence by race and ethnicity, to assess whether such differences contribute to severe maternal morbidity (SMM), and to estimate the contribution of antepartum anemia to SMM and nontransfusion SMM by race and ethnicity. We conducted a population-based cohort study using linked vital record and birth hospitalization data for singleton births at or after 20 weeks of gestation in California from 2011 through 2020. Pregnant patients with hereditary anemias, out-of-hospital births, unlinked records, and missing variables of interest were excluded. Antepartum anemia prevalence and trends were estimated by race and ethnicity. Centers for Disease Control and Prevention criteria were used for SMM and nontransfusion SMM indicators. Multivariable logistic regression modeling was used to estimate risk ratios (RRs) for SMM and nontransfusion SMM by race and ethnicity after sequential adjustment for social determinants, parity, obstetric comorbidities, delivery, and antepartum anemia. Population attributable risk percentages were calculated to assess the contribution of antepartum anemia to SMM and nontransfusion SMM by race and ethnicity. In total, 3,863,594 births in California were included. In 2020, Black pregnant patients had the highest incidence of antepartum anemia (21.5%), followed by Pacific Islander (18.2%), American Indian-Alaska Native (14.1%), multiracial (14.0%), Hispanic (12.6%), Asian (10.6%), and White pregnant patients (9.6%). From 2011 to 2020, the prevalence of anemia increased more than100% among Black patients, and there was a persistent gap in prevalence among Black compared with White patients. Compared with White patients, the adjusted risk for SMM was high among most racial and ethnic groups; adjustment for anemia after sequential modeling for known confounders decreased SMM risk most for Black pregnant patients (approximated RR 1.47, 95% CI 1.42-1.53 to approximated RR 1.27, 95% CI 1.22-1.37). Compared with White patients, the full adjusted nontransfusion SMM risk remained high for most groups except Hispanic and multiracial patients. Within each racial and ethnic group, the population attributable risk percentage for antepartum anemia and SMM was highest for multiracial patients (21.4%, 95% CI 17.5-25.0%), followed by Black (20.9%, 95% CI 18.1-23.4%) and Hispanic (20.9%, 95% CI 19.9-22.1%) patients. The nontransfusion SMM population attributable risk percentages for Asian, Black, and White pregnant patients were less than 8%. Antepartum anemia, most prevalent among Black pregnant patients, contributed to disparities in SMM by race and ethnicity. Nearly one in five to six SMM cases among Black, Hispanic, American Indian-Alaska Native, Pacific Islander, and multiracial pregnant patients is attributable in part to antepartum anemia.

Comment on article "Risk factors associated with preterm birth in a second level hospital"

Preterm birth is a worldwide problem with a high economic impact and morbimortality in children. Therefore, the literature has focused on finding modifiable factors associated with this entity, such as the study "Risk factors associated with preterm birth in a second level hospital," which concluded that "100% of risk factors associated with preterm birth are potentially preventable". Our team reanalyzed the results and found in the regression model that premature rupture of membranes was the only variable associated with preterm birth. This variable is not 100% preventable, so the results found are different from the authors' conclusions.

Horizontally integrated health systems and neonatal intensive care unit (NICU) care for very preterm infants.

Hospital care has consolidated rapidly into health systems in the United States. Infants born very preterm are among the most vulnerable pediatric populations, accounting for the majority of infant deaths each year. The pediatric health care delivery system for infants is unique as the birth hospitalization includes 2 patients, the mother and the infant. Further, regionalization goals for infants who are born preterm require care to be provided at neonatal intensive care units (NICUs) with the capacity to treat them. National patient-level data from the Vermont Oxford Network demonstrates that most very preterm infants were born in a horizontally integrated, multi-hospital system (84%), and they tended to remain in the system for their entire hospitalization, including for risk-appropriate NICU care. Half of the infants were cared for in large systems with more than 10 hospitals that were disproportionately cross-market systems. With high transfer rates between hospitals (21%) it will be important to determine the implications of consolidation for the quality of care and patient-centeredness for families. The care for very preterm infants is important from a policy perspective as hospitalized newborn infants account for 21% of hospitalizations in Medicaid each year and 10% of aggregate hospital costs.

Epidemiology of pediatric hospitalizations at general hospitals and freestanding children's hospitals in the United States: 2019 update.

General hospitals (GH) provide inpatient care for the majority of hospitalized children in the United States, yet the majority of hospital pediatrics research is conducted at freestanding children's hospitals. Updating a prior 2012 analysis, this study used 2019 data to describe characteristics of pediatric hospitalizations at general and freestanding hospitals in the United States and identify the most common and costly reasons for hospitalization in these settings. This study examined hospitalizations in children <18 years using the Healthcare Cost and Utilization Project's 2019 Kids' Inpatient Database, stratifying neonatal and nonneonatal hospital stays. Not applicable. Sociodemographic and clinical differences between hospitalizations at general and freestanding children's hospitals were examined, applying survey weights to generate national estimates. There were an estimated 5,263,218 pediatric hospitalizations in 2019, including 3,757,601 neonatal and 1,505,617 nonneonatal hospital stays. Overall, 88.6% (n = 4,661,288) of hospitalizations occurred at GH, including 97.6% of neonatal hospitalizations and 65.9% of nonneonatal hospitalizations. 11.4% (n = 601,930) of hospitalizations occurred at freestanding children's hospitals, including 2.4% (n = 88,313) of neonatal hospitalizations and 34.1% (n = 513,616) of nonneonatal hospitalizations. In total, 98.9% of complicated birth hospitalizations and 66.0% of neonatal nonbirth hospitalizations occurred at GH. Among nonneonatal stays, 85.2% of mental health hospitalizations, 63.5% of medical hospitalizations, and 61.3% of surgical hospitalizations occurred at GH.

Pediatric Hospitalizations at Rural and Urban Teaching and Nonteaching Hospitals in the US, 2009-2019

National analyses suggest that approximately 1 in 5 US hospitals closed their pediatric units between 2008 and 2018. The extent to which pediatric hospitalizations at general hospitals in rural and urban communities decreased during this period is not well understood. To describe changes in the number and proportion of pediatric hospitalizations and costs at urban teaching, urban nonteaching, and rural hospitals vs freestanding children's hospitals from 2009 to 2019; to estimate the number and proportion of hospitals providing inpatient pediatric care; and to characterize changes in clinical complexity. This study is a retrospective cross-sectional analysis of the 2009, 2012, 2016, and 2019 Kids' Inpatient Database, a nationally representative data set of US pediatric hospitalizations among children younger than 18 years. Data were analyzed from February to June 2023. Pediatric hospitalizations were grouped as birth or nonbirth hospitalizations. Hospitals were categorized as freestanding children's hospitals or as rural, urban nonteaching, or urban teaching general hospitals. The primary outcomes were annual number and proportion of birth and nonbirth hospitalizations and health care costs, changes in the proportion of hospitalizations with complex diagnoses, and estimated number and proportion of hospitals providing pediatric care and associated hospital volumes. Regression analyses were used to compare health care utilization in 2019 vs that in 2009. The data included 23.2 million (95% CI, 22.7-23.6 million) weighted hospitalizations. From 2009 to 2019, estimated national annual pediatric hospitalizations decreased from 6 425 858 to 5 297 882, as birth hospitalizations decreased by 10.6% (95% CI, 6.1%-15.1%) and nonbirth hospitalizations decreased by 28.9% (95% CI, 21.3%-36.5%). Concurrently, hospitalizations with complex chronic disease diagnoses increased by 45.5% (95% CI, 34.6%-56.4%), and hospitalizations with mental health diagnoses increased by 78.0% (95% CI, 61.6%-94.4%). During this period, the most substantial decreases were in nonbirth hospitalizations at rural hospitals (4-fold decrease from 229 263 to 62 729) and urban nonteaching hospitals (6-fold decrease from 581 320 to 92 118). In 2019, birth hospitalizations occurred at 2666 hospitals. Nonbirth pediatric hospitalizations occurred at 3507 hospitals, including 1256 rural hospitals and 843 urban nonteaching hospitals where the median nonbirth hospitalization volumes were fewer than 25 per year. Between 2009 and 2019, the largest decreases in pediatric hospitalizations occurred at rural and urban nonteaching hospitals. Clinical and policy initiatives to support hospitals with low pediatric volumes may be needed to maintain hospital access and pediatric readiness, particularly in rural communities.

O4 - Insights gained from the first three years of a newly established publicly funded homebirth program

There are high levels of consumer demand for homebirth however access is limited due to associated costs and limited numbers of sustainable publicly funded models. BackgroundHomebirth with a qualified midwife, networked into a health system, is a safe option for women with a low-risk pregnancy. This paper has two aims, the first is to describe the implementation of a publicly funded homebirth services with an employed mentor to ensure sustainability. The second is to provide the outcomes from a matched cohort of women (who received care from the same MGP) who gave birth at home compared with those who gave birth in hospital. Findings100 women gave birth at home during the study period, they were more likely to have a normal birth (p <0.001), intact perineum (p<0.0001), less likely to have a postpartum haemorrhage (p<0.0001) compared to the matched cohort of women who birthed in hospital. There were less assisted births and caesarean section births for women who transferred from home to hospital (p<0.0001). Babies born at home were less likely to have an Apgar score of <7 at 5minutes compared to the matched cohort of babies who were born in hospital ConclusionThe improved outcomes for women receiving MGP and choosing to birth at home demonstrate place of birth makes a difference. Implementation of a publicly funded homebirth model requires a specifically employed mentor midwife to enable midwives to transition from providing intrapartum care from hospital to a homebirth setting and ensures the sustainability of the service.The first three years have found improved outcomes for women through a matched cohort study who received care from the same MGP midwives.

Perinatal Care Measures Are Incomplete If They Do Not Assess The Birth Parent-Infant Dyad As A Whole.

Measures of perinatal care quality and outcomes often focus on either the birth parent or the infant. We used linked vital statistics and hospital discharge data to describe a dyadic measure (including both the birth parent and the infant) for perinatal care during the birth hospitalization. In this five-state cohort of 2010-18 births, 21.6percent of birth parent-infant dyads experienced at least one complication, and 9.6percent experienced a severe complication. Severe infant complications were eight times more prevalent than severe birth parent complications. Among birth parents with a severe complication, the co-occurrence of a severe infant complication ranged from 2percent to 51percent, whereas among infants with a severe complication, the co-occurrence of a severe birth parent complication was rare, ranging from 0.04percent to 5percent. These data suggest that measures, clinical interventions, public reporting, and policies focused on either the birth parent or the infant are incomplete in their assessment of a healthy dyad. Thus, clinicians, administrators, and policy makers should evaluate dyadic measures, incentivize positive outcomes for both patients (parent and infant), and create policies that support the health of the dyad.

Perinatal and early life factors and asthma control among preschoolers: a population-based retrospective cohort study

BackgroundPreventing poor childhood asthma control is crucial for short-term and long-term respiratory health. This study evaluated associations between perinatal and early-life factors and early childhood asthma control.MethodsThis retrospective study used...

Challenges and Opportunities for Clinician Implicit Bias Training: Insights from Perinatal Care Stakeholders.

In an attempt to address health inequities, many U.S. states have considered or enacted legislation requiring antibias or implicit bias training (IBT) for health care providers. California's "Dignity in Pregnancy and Childbirth Act" requires that hospitals and alternative birthing centers provide IBT to perinatal clinicians with the goal of improving clinical outcomes for Black women and birthing people. However, there is as yet insufficient evidence to identify what IBT approaches, if any, achieve this goal. Engaging the experiences and insights of IBT stakeholders is a foundational step in informing nascent IBT policy, curricula, and implementation. We conducted a multimethod community-based participatory research study with key stakeholders of California's IBT policy to identify key challenges and recommendations for effective clinician IBT. We used focus groups, in-depth interviews, combined inductive/deductive thematic analysis, and multiple techniques to promote rigor and validity. Participants were San Francisco Bay Area-based individuals who identified as Black or African American women with a recent hospital birth (n=20), and hospital-based perinatal clinicians (n=20). We identified numerous actionable challenges and recommendations regarding aspects of (1) state law; (2) IBT content and format; (3) health care facility IBT implementation; (4) health care facility environment; and (5) provider commitment and behaviors. Patient and clinician insights overlapped substantially. Many respondents felt IBT would improve outcomes only in combination with other antiracism interventions. These stakeholder insights offer policy-makers, health system leaders, and curriculum developers crucial guidance for the future development and implementation of clinician antibias interventions.