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.

Background:
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.

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

Methods:
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.

Results:
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.

Conclusions:
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.