Tuesday, March 18, 2008

The Association between Birth Place, Birth Attendant, and Early Childhood Immunizations

Steve Robison, Immunization Program, Oregon DHS, Health Services, 800 NE Oregon Street, Suite 370, Portland, OR, USA and Martha Priedeman Skiles, Immunization Program, Office of Family Health, State of Oregon Dept of Human Services, 800 NE Oregon Street, Suite 370, Portland, OR, USA.

Learning Objectives for this Presentation:
By the end of the presentation participants will be able to describe how different types of birth locations and attendants are related to immunization seeking and UTD status.

Parental acceptance of alternative views of vaccination can pose a threat to early childhood herd immunity levels. One way to assess this risk is by considering the associations between immunizations, alternative birth locations, and non-traditional birth attendants.

The objective of the present study is to assess the association between type of birth attendant, place of birth, and immunization seeking.

Oregon birth records for 2002, 2003 and 2004 were matched with the Oregon ALERT immunization registry. Shots in a 4:3:1:3:3:1 series received by age two were used for estimating population based rates. Birth location, such as in-hospital, at home, or birth center, and birth attendant were compared to rates of population capture into the registry by age two, and against UTD rates.

Overall 132,473 Oregon births were included in this study. While 97.9% of births were in hospitals, 82.7% had a M.D. as the attendant. The 2,200 children who were born in locations other than a hospital or freestanding birthing center were 8.8 times more likely not to be seeking or receiving immunizations than those born in hospitals. Those with a direct-entry or non-certified midwife in attendance were 7.4 and 8.8 times more likely to not be shot seeking as those with an M.D. However the 19,600 children born with a certified nurse midwife in attendance at a hospital were 1.1 times more likely to be shot seeking than those with an M.D. Similar results were obtained for UTD rates for these groups.

A birth outside of a hospital is a strong factor both for not seeking immunizations, and for not completing series for those that do seek immunizations.