Archives of Gynecology and Obstetrics (2018) 297:871–875
Perinatal outcomes of unplanned out‑of‑hospital deliveries:
a case–control study
· Eliana Muskin Wintner
· Gil Shechter‑Maor
· Yehonatan Pasternak
· Netanella Miller
Received: 17 November 2017 / Accepted: 15 December 2017 / Published online: 13 January 2018
© Springer-Verlag GmbH Germany, part of Springer Nature 2018
Purpose To compare the pregnancy and perinatal outcomes of unplanned home or car births vs. in-hospital deliveries.
Methods A retrospective, case–control study of women who underwent unplanned out-of-hospital deliveries vs. in-hospital
deliveries from 2004 through 2014. Matching was based on gestational age and parity in a ratio of 2:1.
Results There were no signiﬁcant diﬀerences between the groups regarding demographic criteria, prenatal care and delivery
complications. Women who delivered out of hospital (n = 90) had signiﬁcantly fewer cesarean deliveries (1.1 vs. 10.6%;
p = 0.05) and operative deliveries (2.2 vs. 13.3%; p = 0.004) in their obstetrical history than did the control group (n = 180).
Signiﬁcantly more newborns delivered out of the hospital had polycythemia (25.6 vs. 1.7%; p < 0.0001) and hypothermia
(3.3 vs. 0%; p = 0.036) compared to the control group.
Conclusion Women with unplanned out-of-hospital deliveries tend to have fewer complications in their previous deliveries.
Higher rates of polycythemia and hypothermia require attention for neonates born out of the hospital.
Keywords Unplanned out-of-hospital deliveries · Neonatal polycythemia · Neonatal hypothermia · Pregnancy outcomes ·
Throughout history, women have given birth at home. The
ratio between the number of home births and hospital births
in the western world changed dramatically between the ﬁrst
and the second halves of the 20th century, so that in the lat-
ter, the majority of births take place in the hospital . The
debate about the safety of planned home births continues
in the literature, as manifested by the diﬀering policies of
various associations [2, 3].
While planned home births have been studied exten-
sively, accidental out-of-hospital deliveries, which consti-
tute a smaller subgroup of home births, have been given
less attention in the literature. The prevalence of unplanned
out-of-hospital deliveries varies. In the USA, approximately
0.15% of births are unplanned . Similar percentages are
reported in France  and Brazil , and lower in Finland
. The percentages are much higher among centers that
serve more rural areas [8, 9] and increase to up to 3.2% of
all the deliveries in Slovenia .
The few studies that examined unplanned out-of-hospital
deliveries and their obstetric and perinatal outcomes were
relatively small, not representative of diﬀerent population
characteristics, and lacked appropriate comparison groups.
Studies were either population-based [6, 10] or case–con-
trol studies, matched by the timing of delivery, so that the
control group contained the consecutive birth rather than
demographic or obstetrical comparable characteristics [5,
7, 9, 11].
Unplanned home deliveries might be associated with
unfavorable obstetric and perinatal outcomes due to its
accidental nature. The aim of this study is to examine the
* Yael Pasternak
Department of Obstetrics and Gynecology, Meir Medical
Center, 59 Tschernihovsky St., Kfar Saba, Israel
Department of Obstetrics and Gynecology, Shaare Zedek
Medical Center, Jerusalem, Israel
Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv,
Department of Pediatrics A, Schneider Children Medical
Center, Petach Tikva, Israel