This dramatic increase was a result of several changes in the practice environment,
including the introduction of electronic fetal monitoring and a decrease in
operative vaginal deliveries and attempts at
vaginal breech
deliveries (8 — 11).
Planned out - of - hospital birth also had a statistically significant association with higher rates for 5 - minute Apgar scores of less than 7, neonatal seizures, neonatal ventilator support, maternal blood transfusion, and unassisted
vaginal delivery but with lower rates of both admission to neonatal intensive care units and obstetrical interventions,
including induction and augmentation of labor,
operative vaginal delivery, cesarean
delivery, and severe perineal lacerations.