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, MPHsarah.hargand@state.or.us

Acknowledgments and Contact