Comparing the odds of postpartum haemorrhage in planned home birth against planned hospital birth: results of an observational study of over 500,000 maternities in the UK

Abstract

BackgroundThe aim of this study is to compare the odds of postpartum haemorrhage among women who opt for home birth against the odds of postpartum haemorrhage for those who plan a hospital birth. It is an observational study involving secondary analysis of maternity records, using binary logistic regression modelling. The data relate to pregnancies that received maternity care from one of fifteen hospitals in the former North West Thames Regional Health Authority Area in England, and which resulted in a live or stillbirth in the years 1988–2000 inclusive, excluding ‘high-risk’ pregnancies, unplanned home births, pre-term births, elective Caesareans and medical inductions.ResultsEven after adjustment for known confounders such as parity, the odds of postpartum haemorrhage (≥1000ml of blood lost) are significantly higher if a hospital birth is intended than if a home birth is intended (odds ratio 2.5, 95% confidence interval 1.7 to 3.8). The ‘home birth’ group included women who were transferred to hospital during labour or shortly after birth.ConclusionsWomen and their partners should be advised that the risk of PPH is higher among births planned to take place in hospital compared to births planned to take place at home, but that further research is needed to understand (a) whether the same pattern applies to the more life-threatening categories of PPH, and (b) why hospital birth is associated with increased odds of PPH. If it is due to the way in which labour is managed in hospital, changes should be made to practices which compromise the safety of labouring women.

Outcome of Planned Home and Hospital Births among Low‐Risk Women in Iceland in 2005–2009: A Retrospective Cohort Study

“…Observational studies on the outcome of home birth in Western societies have become more frequent in recent years and of greater methodological quality , increasing the scientific knowledge on the safety of home birth. Studies from different countries such as the United States, Canada, the United Kingdom, the Netherlands, Norway, Sweden, Australia, and New Zealand indicate that maternal outcome is equally good or better in home birth than in hospital birth settings, with significantly less intervention and morbidity , except for more frequent prolonged labor . Results on neonatal outcomes in home birth are less consistent: Some studies, predominantly from the United States, indicate that severe neonatal morbidity and mortality are significantly more likely in home than in hospital births , while other studies from the United States, Canada, the Netherlands, Australia, and New Zealand describe either similar or better outcomes on neonatal morbidity, mortality, or need for medical assistance .…”

Maternal Results From Planned Home Births Assisted by Nurses From the Hanami Team in the South of Brazil, 2002-2012

“…49 One study undertaken in the United Kingdom indicated that the risk of hemorrhage in the postpartum period of women attended in the home is two-and-a-half times less than that of women assisted in hospital. 50 Other studies present rates which vary from 0.2% to 9.3%. 5,-6,12,29 Hemorrhage in the postpartum period is one of the urgent reasons for transfer, 45 however, in the present investigation, no puerperal woman was transferred due to this complication, differing from some studies which found a rate varying from 1.0% to 1.5% of transfers.…”

Home birth integration into the health care systems of eleven international jurisdictions

“…The 11 included jurisdictions are Australia, British Columbia (Canada), England, Iceland, Japan, the Netherlands, New Zealand, Norway, Ontario (Canada), Sweden, and Washington State (USA) . Of the 15 questionnaires sent to study authors, 13 were returned, representing 9 of the 11 jurisdictions.…”