Proximity to maternity services and stillbirth risk

Parker, Louise; Dickinson, Heather O; Morton‐Jones, Tony

doi:10.1136/fn.82.2.f167

Cited by 21 publications

(27 citation statements)

References 4 publications

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“…There was no evidence of increasing risk of stillbirth with increasing travel time to hospital (results not presented), confirming the results in Parker and colleagues. 3 …”

Section: Resultsmentioning

confidence: 99%

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Hospital accessibility and infant death risk

Dummer

2004

Archives of Disease in Childhood

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This study of all 4889 infant deaths within the cohort of all 287 993 births in Cumbria, northwest England (1950-93), found no evidence of an increased risk of infant death with greater travel time to hospitals. R isk of mortality from asthma increases with distance from hospital. 1 In the developing world increasing distance from hospital has been shown to be a risk factor for perinatal mortality.2 With respect to the UK, Parker and colleagues 3 found no evidence of an increased risk of stillbirth in relation to increasing distance from maternity hospitals in West Cumbria. Little is known about the risk of infant mortality in relation to hospital accessibility.Accessibility to hospital can be defined in a number of ways: straight-line distance between the hospital and home; road travel distance; road travel time from home to hospital. In this study a geographical information system (GIS) was used to model road travel time to hospital. The aim of the study was to investigate whether geographical accessibility to hospitals affected the risk of infant mortality in Cumbria, northwest England, 1950-93. In addition, we investigated stillbirth risk in Cumbria in relation to hospital accessibility using a larger dataset than that considered by Parker and colleagues. 3 METHODSThis study used the Cumbrian Births Database (CBD), which comprises all 283 668 live births, 4325 stillbirths and 4889 infant deaths in Cumbria, 1950-93 (described in Dummer and colleagues 4 ). Postcode at birth, social class, birth order, multiple births, and year of birth were coded for the cohort and grid references of all births were derived from the postcode at birth. 4 Infant deaths were coded into early neonatal (0-6 days old), neonatal (0-27 days old), and postneonatal (28 days to 1 year).The grid reference and details of all hospitals in Cumbria open between 1950 and 1993 were captured in the GIS database (see fig 1). The road network and boundaries of built-up areas were also captured in the GIS. A travel time to hospital surface of isochrones-lines of equal travel time 5 -was generated by combining the road network, the location of built-up areas (which affects vehicle speeds on the roads), and the location of all hospitals. For the infant death analysis, general hospitals and hospitals with paediatric facilities were incorporated. For the stillbirth analysis all hospitals with a maternity facility were incorporated. Hospital locations included Lancaster Royal Infirmary, which is outside Cumbria but provides maternity and paediatric facilities for those in the south of the county. The grid reference of each birth was used to geographically locate individual births. Travel time to hospital, in relation to hospitals open in the year of birth, was derived for all individual live and still births.Logistic regression was used to investigate the risk of infant mortality (early neonatal, neonatal, and postneonatal deaths) and stillbirth in relation to accessibility to hospital, adjusting for demographic risk factors (year of birth, social class...

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“…There was no evidence of increasing risk of stillbirth with increasing travel time to hospital (results not presented), confirming the results in Parker and colleagues. 3 …”

Section: Resultsmentioning

confidence: 99%

“…In addition, we investigated stillbirth risk in Cumbria in relation to hospital accessibility using a larger dataset than that considered by Parker and colleagues. 3 …”

mentioning

confidence: 99%

Hospital accessibility and infant death risk

Dummer

2004

Archives of Disease in Childhood

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“…Access to maternity care is often limited in rural areas and travel time is longer. Very few studies have been performed on this issue 7,8 . None of them found a significant influence of travel time on perinatal mortality.…”

Section: Introductionmentioning

confidence: 98%

Travel time from home to hospital and adverse perinatal outcomes in women at term in the Netherlands

Ravelli

Jager

Groot

et al. 2010

BJOG: An International Journal of Obstetrics &Amp; Gynaecology

131

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Objective To study the effect of travel time, at the start or during labour, from home to hospital on mortality and adverse outcomes in pregnant women at term in primary and secondary care.Design Population-based cohort study from 2000 up to and including 2006.Setting The Netherlands Perinatal Registry.Population A total of 751 926 singleton term hospital births. MethodsWe assessed the impact of travel time by car, calculated from the postal code of the woman's residence to the 99 maternity units, on neonatal outcome. Logistic regression modelling with adjustments for gestational age, maternal age, parity, ethnicity, socio-economic status, urbanisation, tertiary care centres and volume of the hospital was used.Main outcome measures Mortality (intrapartum, and early and late neonatal mortality) and adverse neonatal outcomes (mortality, Apgar <4 and/or admission to a neonatal intensive care unit). ResultsThe mortality was 1.5 per 1000 births, and adverse outcomes occurred in 6.0 per 1000 births. There was a positive relationship between longer travel time ( ‡20 minutes) and total mortality (OR 1.17, 95% CI 1.002-1.36), neonatal mortality within 24 hours (OR 1.51, 95% CI 1.13-2.02) and with adverse outcomes (OR 1.27, 95% CI 1.17-1.38). In addition to travel time, both delivery at 37 weeks of gestation (OR 2.23, 95% CI 1.81-2.73) or 41 weeks of gestation (OR 1.52, 95% CI 1.29-1.80) increased the risk of mortality.Conclusions A travel time from home to hospital of 20 minutes or more by car is associated with an increased risk of mortality and adverse outcomes in women at term in the Netherlands. These findings should be considered in plans for the centralisation of obstetric care.

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“…When access to emergency obstetric services is examined from the perspective of distance to a hospital, there is more convincing evidence about the relationship between the distance from maternal residence to hospital obstetric services and clinical outcomes. Although early studies found no association between adverse outcomes and the distance from maternal residence to a hospital, further research has demonstrated that perinatal mortality and other adverse neonatal outcomes increase with increasing distance from a hospital setting . A Canadian study of more than 150,000 births found that perinatal mortality was highest in communities more than 4 hours from maternity services, and preterm birth was more likely among individuals without access to local services .…”

Section: Introductionmentioning

confidence: 99%

“…The proximity to emergency obstetric services, measured as either distance or time, is a persistent and critical concern for those who plan and deliver maternal and newborn care. Previous literature has focused on either the time within an institution from identification of an emergency to the availability of emergency obstetric services, such as cesarean birth, or the distance from maternal residence to hospital maternity services . Within hospitals, optimizing the decision‐to‐delivery interval, that is, the time from which when the need for a cesarean is identified until birth, is seen as a means to ensuring safety and high‐quality care .…”

Section: Introductionmentioning

confidence: 99%

Distance from Home Birth to Emergency Obstetric Services and Neonatal Outcomes: A Cohort Study

Darling¹,

Lawford²,

Wilson³

et al. 2018

J Midwife Womens Health

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Introduction 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. Methods 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. Results 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). Discussion 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.

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Proximity to maternity services and stillbirth risk

Cited by 21 publications

References 4 publications

Hospital accessibility and infant death risk

Hospital accessibility and infant death risk

Travel time from home to hospital and adverse perinatal outcomes in women at term in the Netherlands

Distance from Home Birth to Emergency Obstetric Services and Neonatal Outcomes: A Cohort Study

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