Accidental out-of-hospital births in Finland: incidence and geographical distribution 1963-1995.

BACKGROUND: The study aims to describe the incidence and geographical distribution of accidental out-of-hospital births (accidental births) in Finland in relation to the changes in the hospital network, and to compare the perinatal outcomes of accidental births and all hospital births. METHODS: Data for the incidence and distribution analyses of accidental births were obtained from the official statistics between 1962 and 1973 and from the national Medical Birth Registry (MBR) in 1992-1993. The infant outcomes were analyzed for the MBR data in 1991-1995. RESULTS: Between 1963 and 1975 the central hospital network expanded and by 1975 they covered 72% of births. The number of small maternity units has decreased since 1963. The incidence of accidental births decreased between 1963 and 1973, from 1.3 to 0.4 per 1000 births, and rose by the 1990s to 1/1000. In the 1990s the parity adjusted risk of an accidental birth was higher for residents of northern than of southern Finland, OR 2.51 (CI 1.75-3.60), and for residents of rural compared to urban municipalities, OR 3.26 (CI 2.48-4.27). The birthweight adjusted risk for a perinatal death was higher in accidental births than in hospital births, OR 3.11 (CI 1.42-6.84). CONCLUSIONS: A temporal correlation between closing of small hospitals and an increase in accidental birth rates was detected. Due to the poor infant outcomes of accidental births, centralization policies should include measures to their prevention.