Sarah Hargand , MPH Research Analyst Center for Health Statistics Oregon Health Authority

1. Oregon’s HB 2380 Gathering data on planned place of birth Sarah Hargand, MPH Research Analyst Center for Health Statistics Oregon Health Authority

2. HB2380 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.

3. Overview Background 2011 Legislative Session Out-of-Hospital Births in Oregon Midwives Implementation Training Quality Assurance Analysis Preliminary Report Special Perinatal Case Fatality Report

4. 2011 Legislative Session

5. 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.”

6. Out-of-Hospital Births U.S. rate not available

7. Oregon Births Occurring Out-of-Hospital, 2011

8. Midwives 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.

9. Implementation Two new questions are added to the birth and fetal death certificates effective January 1, 2012. Did mother go into labor planning to deliver at home or at a freestanding birthing center? If yes, the planned primary attendant type at onset of labor was:

10. Implementation

11. Implementation Total Cost: $38,757.25 Total Staff Time: $26,257.25 Hours: 682.5 Vendor Costs: $12,500.00 Hours: 85

12. Quality Assurance Quality assurance started in February and included: Response rate Verification of planned out-of-hospital birth 3) Verification of attendant type

13. Preliminary Report

14. Special Report: Maternal Characteristics

15. Special Report: Medical & Health Characteristics

16. Special Perinatal Fatality Case Review • 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

17. 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

18. 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);

19. What’s Next?

20. Acknowledgments and Contact Genevieve Buser, MD, MSHP EIS Fellow, Oregon Public Health Division Anna Stiefvater, RN, MPH Perinatal Nurse Consultant, Maternal and Child Health Katrina Hedberg, MD, MPH State Epidemiologist and Chief Science Officer Contact: Sarah Hargand, MPH sarah.hargand@state.or.us