J Midwifery Womens Health. 2019 Mar;64(2):170-178. doi: 10.1111/jmwh.12896. Epub 2018 Oct 16.
Little is known about the relationship between distance from hospital services and the outcomes of planned home births. We examined whether greater driving distance from a hospital with continuous cesarean capability was associated with a higher risk of adverse neonatal outcome among individuals who were planning to give birth at home.
Using an intention-to-treat analysis, we conducted a population-based cohort study of 11,869 individuals who planned to give birth at home in Ontario, Canada, between April 1, 2012, and March 31, 2015. We used postal codes to determine the driving time from maternal residence to the closest hospital offering level 2 or higher maternity care services (ie, hospital with continuous cesarean birth capability). We used log binomial regression analysis to compare the outcomes of individuals who planned a birth more than a 30-minute drive from a level 2 hospital with those of individuals whose births were planned to occur within 30 minutes. We adjusted for maternal age, parity, gestational age, season, and maternal material deprivation quintile.
We found no statistically significant difference in the rates of 5-minute Apgar scores less than 7 (adjusted relative risk [aRR], 1.02; 95% CI, 0.95-1.10; P = .58), perinatal mortality, meconium aspiration syndrome, and emergency medical service usage. Neonates born to individuals who planned to give birth at a greater distance from a hospital had a lower rate of neonatal intensive care unit admission (aRR, 0.6; 95% CI, 0.44-0.81; P = .001).
We found no increased risk of adverse neonatal outcomes for births that were planned to occur more than 30 minutes from a hospital. Our findings can be considered, along with individual risk factors and contextual factors, in decision making about the choice of home birth for individuals who live more than half an hour from a hospital with cesarean capacity.
对于离医院服务的距离与计划在家分娩的结果之间的关系，人们知之甚少。我们研究了计划在家分娩的个体与具有连续剖宫产能力的医院之间的距离是否与新生儿不良结局的风险增加有关。
使用意向治疗分析，我们对 2012 年 4 月 1 日至 2015 年 3 月 31 日期间在加拿大安大略省计划在家分娩的 11869 名个体进行了一项基于人群的队列研究。我们使用邮政编码来确定从产妇住所到提供 2 级或更高产科护理服务（即具有连续剖宫产能力的医院）的最近医院的驾车时间。我们使用对数二项式回归分析来比较计划在距离 2 级医院 30 分钟车程以上分娩的个体与计划在 30 分钟内分娩的个体的结局。我们调整了产妇年龄、产次、胎龄、季节和产妇物质剥夺五分位数。
我们发现，5 分钟 Apgar 评分低于 7 的发生率（调整后的相对风险 [aRR]，1.02；95%CI，0.95-1.10；P=.58）、围产儿死亡率、胎粪吸入综合征和使用急救医疗服务无统计学显著差异。与计划在距离医院较远的地方分娩的个体相比，新生儿重症监护病房入院率较低（aRR，0.6；95%CI，0.44-0.81；P=.001）。
我们发现，计划分娩距离医院 30 分钟以上的新生儿不良结局风险并未增加。在考虑个体风险因素和背景因素的情况下，可以考虑将这些发现用于选择离家超过半小时且具有剖宫产能力的医院的个体的家庭分娩。
