COVID-19 influences increase in births outside of Oregon hospitals
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Pregnant women in Oregon are avoiding the hospital for their birthing plans and turning to birthing centers or giving birth at home, likely due to the COVID-19 pandemic, according to a study in American Journal of Obstetrics & Gynecology.
The findings reflect a larger national trend of more women choosing community births over hospitals amid the pandemic.
“In Oregon, in-hospital births declined significantly during the first year of COVID-19 and affected system-owned hospitals more than independent ones. Similar dynamics may be present nationwide as COVID-19 continues in the U.S.,” Anna Jo Bodurtha Smith, MD, MPH, MSc, a gynecologic oncology fellow at the Perelman School of Medicine at the University of Pennsylvania, and colleagues wrote.
Using two Oregon databases — the Oregon Health Authority Vital Statistics and the Oregon Perinatal Collaborative — as well as the Johns Hopkins COVID-19 data tracker and the Health Systems Provider Database, Smith and colleagues analyzed whether COVID-19 was affecting where Oregon women gave birth. Whether these location changes differed between system-owned and independent hospitals or between urban and rural areas during 2020 was also explored.
The numbers of actual vs. predicted hospital births and system-owned hospital births were statistically significantly decreased from March to December 2020 (P < .001 for all months), and rates of birth at birthing centers or at home significantly increased in spring 2020 (P < .01).
Actual births in the hospital declined by 4.4% compared with average rates in 2018 and 2019. That net decline reflected a 4.6% reduction in births at system-owned hospitals but a net increase of 3% of births at independently owned hospitals. Births outside hospitals increased by 12.5% — specifically due to a 13.5% increase in births at birthing centers and an 11.9% increase in births at home, according to the study.
The researchers also found that both urban and rural areas were trending toward fewer hospital births.
Perspective
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This study shows a slight increase of home births in Oregon in 2020 at the very onset of COVID-19 compared with prior years, but it then shows a trend toward return to pre-pandemic levels in later months of 2020. It does not add significantly more information to a prior study done nationally that showed an increase in home births during year 1 of the epidemic. Unfortunately, this Oregon study misses a lot of information shown in the national study, such as an increase of high-risk pregnancies and worsening neonatal outcomes during year 1 of COVID-19 compared with prior years.
Reference:
Grünebaum A, et al. Am J Obstet Gynecol. 2021;doi:10.1016/j.ajog.2021.11.1346.
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