Introduction. Women planning for home birth are transferred to hospital in case of

BackgroundWhether certain birth positions are associated with perineal injuries and severe perineal trauma (SPT) is still unclear. The objective of this study was to describe the prevalence of perineal injuries of different severity in a low-risk population of women who planned to give birth at home and to compare the prevalence of perineal injuries, SPT and episiotomy in different birth positions in four Nordic countries.MethodsA population-based prospective cohort study of planned home births in four Nordic countries. To assess medical outcomes a questionnaire completed after birth by the attending midwife was used. Descriptive statistics, bivariate analysis and logistic regression were used to analyze the data.ResultsTwo thousand nine hundred ninety-two women with planned home births, who birthed spontaneously at home or after transfer to hospital, between 2008 and 2013 were included. The prevalence of SPT was 0.7 % and the prevalence of episiotomy was 1.0 %. There were differences between the countries regarding all maternal characteristics. No association between flexible sacrum positions and sutured perineal injuries was found (OR 1.02; 95 % CI 0.86–1.21) or SPT (OR 0.68; CI 95 % 0.26–1.79). Flexible sacrum positions were associated with fewer episiotomies (OR 0.20; CI 95 % 0.10–0.54).ConclusionA low prevalence of SPT and episiotomy was found among women opting for a home birth in four Nordic countries. Women used a variety of birth positions and a majority gave birth in flexible sacrum positions. No associations were found between flexible sacrum positions and SPT. Flexible sacrum positions were associated with fewer episiotomies.

In this population of healthy women with a low prevalence of interventions, the total duration of labor was fairly similar to what is described in the literature for multiparas, but longer for primiparas. Although the duration of the phases of labor differed among countries, it was to a minor extent associated with severe outcomes.

(Acta Obstet Gynecol Scand. 2016;95:420–428) Research has shown that of women planning to give birth at home in western countries up to one-third are transferred to a hospital during labor or after the birth. The objective of this study was to describe how often women and neonates were transferred from home to a hospital during labor or after birth; the indications for transfer; how long before or after birth the transfer occurred; the mode and duration of transfer; and the proportion of transfers classified as potentially urgent.