Transfers to hospital in planned home birth in four Nordic countries - a prospective cohort study

Acta Obstet Gynecol Scand. 2016 Apr;95(4):420-8. doi: 10.1111/aogs.12858. Epub 2016 Feb 29.

Abstract

Introduction: Women planning a home birth are transferred to hospital in case of complications or elevated risk for adverse outcomes. The aim of the present study was to describe the indications for transfer to hospital in planned home births, and the proportion of cases in which this occurs.

Material and methods: Women in Norway, Sweden, Denmark and Iceland who had opted for, and were accepted for, home birth at the onset of labor, were included in the study. Data from 3068 women, 572 nulliparas and 2446 multiparas, were analyzed for proportion of transfers during labor and within 72 h after birth, indications for transfer, how long before or after birth the transfer started, time from birth to start of transfer, duration and mode of transfer, and whether the transfer was classified as potentially urgent. Analyses were stratified for nulliparity and multiparity.

Results: One-third (186/572) of the nulliparas were transferred to hospital, 137 (24.0%) during labor and 49 (8.6%) after the birth. Of the multiparas, 195/2446 (8.0%) were transferred, 118 (4.8%) during labor and 77 (3.2%) after birth. The most common indication for transfers during labor was slow progress. In transfers after birth, postpartum hemorrhage, tears and neonatal respiratory problems were the most common indications. A total of 116 of the 3068 women had transfers classified as potentially urgent.

Conclusions: One-third of all nulliparous and 8.0% of multiparous women were transferred during labor or within 72 h of the birth. The proportion of potentially urgent transfers was 3.8%.

Keywords: Planned home birth; indications for transfers; midwifery; potentially urgent transfer; transfer to hospital.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Female
  • Home Childbirth*
  • Hospitalization / statistics & numerical data*
  • Humans
  • Obstetric Labor Complications / therapy*
  • Patient Transfer*
  • Pregnancy
  • Pregnancy Outcome
  • Prospective Studies
  • Registries
  • Risk
  • Scandinavian and Nordic Countries