Introduction: Loss of hospital-based intrapartum services is associated with increases in out-of-hospital births, but less is known about associations with planned home birth. This study explores the impact of distance to hospital-based intrapartum care on planned home birth. Methods: Public-use Minnesota birth certificate data were merged with Minnesota Hospital Annual Report data (2011-2016) to test the relationship of miles from maternal residence to hospital-based intrapartum care with planned home birth in Minnesota. Logistic regression models estimated the odds of a planned home birth versus hospital birth as a function of miles to hospital-based intrapartum care. Results: The number of hospitals offering birth services in Minnesota declined by 11% from 2011 to 2016. Moderate (>20-50 miles) and great (>50 miles) distances to nearest hospital-based intrapartum care were associated with increased odds of planned home birth compared with short distances (≤20 miles). Adjusted odds ratios were 3.31 (95% CI, 3.04-3.61) and 3.89 (95% CI, 2.37-6.37), respectively, after adjusting for maternal education, age, and race. Planned home birth was the intended birth setting in 4.3% of births among those living great distances from hospital-based intrapartum care, compared with 1.0% among those living a short distance from hospital-based intrapartum care. Discussion: Better understanding of how geographical barriers affect preferred birth settings can inform efforts to reduce the impact of hospital-based intrapartum service loss on rural women and their birth outcomes.
Bibliographical noteFunding Information:
The authors wish to acknowledge the University of Minnesota's Center for Leadership Education in Maternal and Child Health for financial support in acquiring data, Kate Carlson with the University of Minnesota's U‐Spatial for geographic information system expertise and assistance, and Dr. Carrie Henning‐Smith for her input and feedback on the article.
© 2020 by the American College of Nurse-Midwives
- birth setting
- health services accessibility
- home childbirth
- natural childbirth
- rural health services
PubMed: MeSH publication types
- Journal Article