This retrospective study sought to evaluate the prevalence, risk factors, and morbidity and mortality of prehospital births. Prehospital births are any that occur out of the hospital (outborn), or within the hospital confines but without a physician or nurse/midwife in attendance. During the 4-year period of review at an inner city urban hospital, 151 (1.8%) infants were outborn while 8,169 (98.2%) were born in hospital (inborn). All outborn infants were evaluated by a neonatal team, and 29% required neonatal intensive care (NICU) admission versus 15% of the inborn infants. Thirty-five percent of outborn and 21% of inborn infants were exposed to illicit drugs. Seventy-six percent of outborn and 16% of inborn infants received no or poor prenatal care. The outborn neonatal death rate was 80 per 1000 live births, and accounted for 17% of total neonatal deaths, whereas the inborn neonatal death rate was 7 per 1000 live births. All deaths among outborn infants were low birth weight (LBW) infants (<2,500 g). The authors conclude that the differences in morbidity and mortality of outborn infants are due to the vulnerability of LBW, and their need for intensive resuscitation. Moreover, they suggest that admission to NICU alone likely underrepresents the true morbidity of outborn infants.