Childbirths at home and in birthing centers rose during COVID-19: Oregon 2020 vs prior years





Objective


In March 2020, as COVID-19 was first recognized in the United States, reports emerged about how severe COVID-19 could be among pregnant individuals, and clinicians had to speculate about its potential effects on newborns. Out of concern for patient, clinician, and neonatal safety, system-based hospitals—hospitals owned by an organization operating outpatient practices, including primary care—rapidly implemented COVID-19 policies, restricting companions during childbirth and separating parents with COVID-19 from their babies. , Fear of COVID-19 and commensurate changes in hospital policies may have led some pregnant individuals to choose to deliver in independent hospitals, in birthing centers, or at home. , Our objectives were to compare place of birth between 2020 and years before the COVID-19 pandemic and to investigate whether changes in place of birth differed between system-owned and independent hospitals and urban and rural regions in Oregon.


Study design


We connected 2 Oregon data sources (Oregon Health Authority Vital Statistics and Oregon Perinatal Collaborative) with the Johns Hopkins COVID-19 data tracker and the novel Health Systems Provider Database to examine overall trends in place of birth (in the hospital, in a birthing center, or at home) between system-owned and independent hospitals and between urban and rural areas. Birth location was defined as rural or urban using county-type designation from the Centers for Medicaid & Medicare Services. The institutional review boards of the Boston Children’s Hospital and Harvard University approved this study.


We used regression modeling and Student t tests to compare predicted birth numbers with actual birth numbers by facility type, system-owned or independent status, and urban or rural location between 2020 and previous years in 2 ways: predicted 2020 values using (1) 2010–2019 data and (2) an average of 2 preceding years, 2018–2019. These models produced (1) a predicted number of births by place for 2020 vs previous years had births followed existing trends and (2) a percentage change in place of births from 2018 to 2020. We considered a 2-sided P value of.05 to be significant.


Results


Comparing actual births in 2020 with predicted births in 2020, decreases in hospital birth were statistically significantly from March 2020 to December 2020, the period affected by COVID-19 ( P <.001 for all months), and the decrease remained greater than predicted by secular trends. Decreases in system-owned hospital births were significant from March 2020 to December 2020 ( P ≤.001 for all months). Increases in birthing center and at-home births were statistically significant in the spring of 2020 ( P <.01) during the first wave of COVID-19. ( Table 1 )



Table 1

Predicted vs actual 2020 births by facility type












































































































































































































































































































Month Year Facility type Actual births in 2020 Predicted births in 2020 Difference (actual vs predicted) Student t test P value
Jan. 2020 Hospital 3220 3317 −97 .016
Feb. 2020 Hospital 3036 3114 −78 .051
March 2020 Hospital 3300 3513 −213 <.001 a
April 2020 Hospital 3236 3441 −205 <.001 a
May 2020 Hospital 3354 3652 −298 <.001 a
June 2020 Hospital 3290 3583 −293 <.001 a
July 2020 Hospital 3550 3695 −145 <.001 a
Aug. 2020 Hospital 3381 3737 −356 <.001 a
Sept. 2020 Hospital 3212 3536 −324 <.001 a
Oct. 2020 Hospital 3195 3440 −245 <.001 a
Nov. 2020 Hospital 2875 3218 −343 <.001 a
Dec. 2020 Hospital 3060 3337 −277 <.001 a
Jan. 2020 Birthing center 38 50 −12 <.001 a
Feb. 2020 Birthing center 49 46 +3 .318
March 2020 Birthing center 49 56 −7 .021
April 2020 Birthing center 69 57 +12 <.001 a
May 2020 Birthing center 65 58 +7 .026
June 2020 Birthing center 59 58 +1 .716
July 2020 Birthing center 59 60 −1 .712
Aug. 2020 Birthing center 60 59 +1 .844
Sept. 2020 Birthing center 56 53 +3 .287
Oct. 2020 Birthing center 65 52 +13 <.001 a
Nov. 2020 Birthing center 51 54 −3 .270
Dec. 2020 Birthing center 53 52 +1 .741
Jan. 2020 Home 56 70 −14 <.001 a
Feb. 2020 Home 66 67 −1 .758
March 2020 Home 72 76 −4 .334
April 2020 Home 99 80 +19 <.001 a
May 2020 Home 103 77 +26 <.001 a
June 2020 Home 95 78 +17 <.001 a
July 2020 Home 91 77 +14 <.001 a
Aug. 2020 Home 75 77 −2 .575
Sept. 2020 Home 71 69 +2 .599
Oct. 2020 Home 78 69 +9 .019
Nov. 2020 Home 81 64 +17 <.001 a
Dec. 2020 Home 69 68 +1 .785

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Aug 28, 2022 | Posted by in GYNECOLOGY | Comments Off on Childbirths at home and in birthing centers rose during COVID-19: Oregon 2020 vs prior years

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