Transfer to hospital in planned home births: a systematic review Full Text
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This is because a well designed study would look at the intended birth place (those who “planned” to give birth at home with those who “planned” to give birth in the hospital) rather than the actual place of birth. Second, many US studies utilize birth certificate data which has limitations and inaccuracies. Some states do not distinguish between planned and unplanned home births on birth certificates so unplanned home births may be unintentionally reported. According to a study that analyzed birth outcomes, there was a 41% increase in home births from 2004 to 2010. Researchers found low-risk women had higher rates of vaginal birth without intervention. There was also no increase in adverse outcomes for low-risk women.
It is important for home birth parents to plan for the possibility of a transfer to the hospital. A study of 5,418 U.S. women who gave birth at home under the care of CPMs found that 12% of women had to transfer to the hospital during labor or after birth (Johnson et al., 2005). About 9% or three-fourths of these transfers were considered non-urgent.
What are the possible risks of a planned home birth?
For some people with certain health conditions, as well as those who have not given birth before, the risks of a planned home birth may be higher than they are for others. In the present review, we found that the proportion of transfer from home to hospital during and after planned home births varied from 9.9% to 31.9% across the study populations. In nulliparous, this proportion varied from 23.4% to 45.4%, and in multiparous, it ranged from 5.8% to 12.0%. Slow progress in labour was the most frequent indication for transfer in nulli- and multiparous women, occurring in 5.2% to 9.8% of all planned home births. Transfers because of foetal distress ranged from 1.0% to 3.6% . Anna planned a homebirth for her first baby, but after a long labour which did not seem to be progressing, she transferred to hospital hoping to have an epidural.
You could also consider hiring an independent midwife who specialises in home births, so that you know she will only suggest transfer if she really does think it necessary. More details about hiring independent midwives in the UK are available online. Bear in mind also that many transfers occur at the mother's request - when she is tired and would like labour to be accelerated, and/or she has had enough pain and wants to have an epidural. So it is possible that you would be asking the midwife to transfer, rather than the other way around. One common reason for transfer is that meconium is found in the waters.
Use these signs that it’s time to go to the hospital to write your home birth plan
There is a great deal of debate in the US over whether homebirth is safe. Several studies show that homebirth is as safe as birth in the hospital for low-risk women attended by well-qualified birth providers who have ready access to back-up care if complications arise. Obstetricians and Gynecologists are surgeons specializing in the pathology of women’s reproductive organs. Many wonderful OBs who practice in the hospital work as backup doctors for local Midwives who attend homebirth. Incidentally, that’s a decent way to find an OB who respects the natural process of labor and a family’s right to informed decisions about their bodies.
Of first-time moms choosing home birth, up to 37 percent transfer to a hospital, largely because the baby is unable to move through the birth canal. Finding a home birth midwife in California is fairly easy because the state allows certified midwives to practice even if they are not already nurses. This is not the case in some other states that don't allow midwives or limit the number of legal practitioners available.
What is in This Collection?[edit | edit source]
Recent figures received from the New Zealand College of Midwives indicate that the rate of Home Births in New Zealand appears to be on the increase. The Home Birth Aotearoa community believe the choice to birth at home is the best for women, babies, whānau and the wider community. There are several other types of midwives, including certified midwives , direct-entry midwives, and lay midwives. There is a lot of controversy over who should be eligible to give birth at home.
We considered that the definition of emergency transfer from the study in the Netherlands was the best and most detailed . Fifteen 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%.
What might cause the need to go to a hospital?
For instance, the rate of cesarean sections in the US doubled between 1970 and 2010. American women today are 50% more likely to die in childbirth than their mothers . In an effort to avoid seemingly unnecessary intervention, it is not surprising that some women have turned again to home birth. Modern maternity care has provided some labor and life-saving advancements. Yet at the same time, birth has become increasingly medicalized. When birth is approached as a medical event it can lead to interventions, that would otherwise be good & necessary, being overused and creating problems that would otherwise not exist.
The most common non-urgent reasons for transfer were for failure to progress (5.7% of all home births), need for pain relief (2.2%), and maternal exhaustion (2.1%). The evidence on the safety of homebirth in the US is inconclusive. Each birth setting study has had limitations and none of the available research on birth settings meets the “gold standard” in medical research.
Only studies with births assisted by an authorised midwife or medical doctor were included. To the best of our knowledge, the scope of transfer in planned home births has not been assessed in a systematic review. There is little systematic knowledge on the frequency of women and neonates who are transferred from home to hospital in planned home births, and indications for transfers.
Eight of the included studies reported the proportion of emergency transfers, and it varied from 0% to 5.4% . Methodological quality was assessed by using the Norwegian Knowledge Centre for the Health Services tool for assessing the risk of bias . Now that you know all of the reasons you might need to transfer to the hospital during your home birth, you are ready to write a more informed home birth plan. Lastly, if at any point during your home birth labor you feel like you want to transfer to the hospital, speak up! This is because in a hospital setting there will be more advanced monitoring devices and access to intervention and medical support should they be needed. The presence of meconium (baby’s first poop) in your amniotic fluid is the second most common cause for hospital transfer during home births.
Such transfers can occur before labour starts, during labour, or after labour. When booking a home birth, you might want to know what your chances of having to transfer are, and what are the most common reasons for transfer. Nationwide, planned home births have roughly twice the rate of infant death as hospital births.
These can lead to ineffective pushing, vaginal surgical cuts and tearing, instrumental vaginal birth, and a cesarean section. If you're considering an at-home birth in the United States, there are several factors you may want to review to ensure your and your baby's safety. Ideally, your home or other birth location is within 15 minutes of a hospital with 24-hour maternity care. Between 0% and 0.2% of the women were transferred because of postpartum haemorrhage, and between 0.3% and 1.4% of neonates were transferred because of respiratory problems .
If anything seems to be atypical, unusual, or abnormal your midwife will likely err on the side of caution and recommend a hospital transfer. The unknown will be erased and you’ll be better able to visualize and plan for every possible home birth outcome by knowing the common and signs and reasons that it’s time to head to the hospital. Genesis Dove transferred to hospital for induction after her labour never really got going... Helen Gardner transferred to hospital after a home birth to have some stitching, but her triumphant story makes it clear that this has not marred her memories of the birth. Kiara planned a home birth for her first baby but ended up with an emergency caesarean because Ben was not only facing the wrong way , but his head was deflexed and asynclitic - tilted up and to the side. The journey to hospital was more 'eventful' than you might wish for, and consequently took a lot longer than it should have.
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