Out-of-Hospital and Emergency Department Births: A Review of Preparedness and Management

Out-of-hospital births represent a small but growing proportion of deliveries in the United States. Although many of these births are planned and supervised by a midwife, deliveries that occur outside the labor and delivery suite present risks to both the birthing person and newborn. National organizations such as the American College of Obstetrics and Gynecology and the American Academy of Pediatrics generally caution against planned home births, but they do provide recommendations to reduce risk, including careful selection of appropriate candidates, presence of qualified clinical practitioners, and quick and reliable access to a higher level of care. Unplanned births in the community requiring responses from emergency personnel or emergency department births also present challenges for health care practitioners and departments that have limited experience with such cases. This review summarizes strategies to prepare for and manage these births, emphasizing care of the neonate.