Born before Arrival in NSW (2000-2011): A linked population data study of incidence, location, associated factors and maternal and neonatal outcomes

Background: There is evidence that the rate of babies Born Before Arrival (BBA) may be increasing within Australia due to the closure of maternity units and geographic distances to places of birth. The BBA rate in New South... [ view full abstract ]

Background: There is evidence that the rate of babies Born Before Arrival (BBA) may be increasing within Australia due to the closure of maternity units and geographic distances to places of birth. The BBA rate in New South Wales (NSW) is not known and the associated factors for BBA are not elucidated. The effect of “freebirth” (a birth not attended by any health professional) has not previously been investigated within this setting as a potential factor in the occurrence of BBA, and the freebirth rate appears to be rising. Our aim was to determine incidence, associated factors, outcomes and geographic occurrence of BBA in NSW.

Method: A linked population data study involving population-based surveillance systems was undertaken for the years 2000-2011 in NSW Australia comparing women who underwent BBA when compared to women who birthed in hospital/birth centre settings. Comparisons were also made in reference to geographical occurrence of planned home birth events and intervention in a previous birth.

Results: During the time period there were 1 097 762 births and a BBA rate of 4.2 per 1000 births (n=4945). The BBA rate changed from 4.2 to 4.8 per 1000 births over time. Neonates were more likely to be premature, of lower birth weight, be female, and/or be admitted to a special care nursery or neonatal intensive care unit. Women in the BBA cohort were more likely to be in the lowest socio-economic decile, multiparous, have higher rates of smoking and more likely to suffer a postpartum haemorrhage requiring transfusion than the non-BBA cohort. BBA more commonly occurred in geographical areas where the distance to a maternity unit is greater than two hours drive and in coastal regions where there is also a high rate of homebirth. Women who had more than one BBA in the time period however were more likely to be of higher socio-economic status.

Discussion: BBA occurs more frequently in multiparous women of lower socio-economic status, unless women have several BBA’s. There potentially is an effect of geography on the occurrence of BBA, as geographic area of high homebirth and BBA co-exists, indicating that freebirth followed by an unplanned transfer to hospital may be occurring.

Conclusion: More research needs to be done examining the drivers behind BBA

Ethical approval was obtained from the NSW Population and Health Services Research Ethics Committee, Protocol No.2010/12/291.

Nil Funding

The results will be available at the conference and are currently under review for a publication

Preferred presentation mode oral