Transfer to hospital in planned home births: a systematic review

Abstract

BackgroundThere is concern about the safety of homebirths, especially in women transferred to hospital during or after labour. The scope of transfer in planned home births has not been assessed in a systematic review. This review aimed to describe the proportions and indications for transfer from home to hospital during or after labour in planned home births.MethodsThe databases Pubmed, Embase, Cinahl, Svemed+, and the Cochrane Library were searched using the MeSH term “home childbirth”. Inclusion criteria were as follows: the study population was women who chose planned home birth at the onset of labour; the studies were from Western countries; the birth attendant was an authorised midwife or medical doctor; the studies were published in 1985 or later, with data not older than from 1980; and data on transfer from home to hospital were described. Of the 3366 titles identified, 83 full text articles were screened, and 15 met the inclusion criteria. Two of the authors independently extracted the data. Because of the heterogeneity and lack of robustness across the studies, there were considerable risks for bias if performing meta-analyses. A descriptive presentation of the findings was chosen.ResultsFifteen studies were eligible for inclusion, containing data from 215,257 women. The total proportion of transfer from home to hospital varied from 9.9% to 31.9% across the studies. The most common indication for transfer was labour dystocia, occurring in 5.1% to 9.8% of all women planning for home births. Transfer for indication for foetal distress varied from 1.0% to 3.6%, postpartum haemorrhage from 0% to 0.2% and respiratory problems in the infant from 0.3% to 1.4%. The proportion of emergency transfers varied from 0% to 5.4%.ConclusionFuture studies should report indications for transfer from home to hospital and provide clear definitions of emergency transfers.

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

“…The majority of the findings are similar to those already published in studies undertaken in Brazil and other, developed, countries. 4,6,10,12-13, [23][24][25][26] One of the limitations for discussing the present study's findings is the meager publication of quantitative Brazilian data regarding assistance at home so as to compare the results obtained. [10][11]19 In relation to the sociodemographic characteristics, the age range of the majority of the women was below that found in the international studies (between 30 and 34 years old) [26][27][28][29][30] and in another Brazilian study (30-35 years old).…”

“…3,28 The systematic review published in 2014, on the other hand, found even lower rates of transfer (0% to 0.2%). 25 Attention is called to the low percentage of cesareans (9.9%) in the total of the sample studied (212) when compared with the Brazilian rate cited above, and with the WHO recommendations that this rate should be below 15%. 51 This finding was similar to that of a study undertaken in Canada, in which 12.0% of the primiparous women, and 1.6% of the multiparous women underwent cesarean section.…”

“…In one systematic review, published in 2014, the rates of transfer varied from 9.9% to 31.9%, it being the case that among primiparous women this number reached 45.4%, and in the multiparous women, 12.0%, occurring with greater frequency in labor (8.2% to 24.1%), due to slow progression (5.2% to 9.8%). 25 Regarding complications after birth, delayed expulsion of the placenta was the most common, but no woman needed to be transferred for this reason. Generally speaking, the studies do not present this data.…”

Planned Out-of-Hospital Birth and Birth Outcomes

“…The observed rate of 16.5% in this study is informative and is consistent with rates reported in a recent systematic review of transfers in developed countries (including the United States), in which intrapartum transfer rates ranged from 10 to 17%. 21 The limitations of our study require consideration. First, a major limitation is the inability in the case of planned home births to distinguish between transfers from birth centers and transfers from home.…”

Primiparous women's preferences for care during a prolonged latent phase of labour

“…The definition of normality regarding the latent phase is incongruous and a review of obstetrical textbooks showed that the length of normal latent phase of labour is described as between 2 and 20 hours [12]. Internationally most clinicians continue to use Friedman's original definition of a prolonged latent phase as more than 20 hours for nulliparous and 14 hours in multiparous women [13].…”