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Open Access Highly Accessed Research article

Transfer to hospital in planned home births: a systematic review

Ellen Blix12*, Merethe Kumle3, Hanne Kjærgaard45, Pål Øian16 and Helena E Lindgren78

Author Affiliations

1 Department of Clinical Medicine, Women’s Health and Perinatology Research Group, Faculty of Health Sciences, University of Tromsø, Tromsø, Norway

2 Department of Clinical Research, University Hospital of North Norway, Tromsø, Norway

3 Department of Surgery, University Hospital of North Norway, Narvik, Norway

4 The Research Unit, Women’s and Children’s Health, The Juliane Marie Centre for Women, Children and Reproduction, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark

5 The Institute of Clinical Medicine, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark

6 Department of Obstetrics and Gynaecology, University Hospital of North Norway, Tromsø, Norway

7 Department of Health and Caring Sciences, University of Gothenburg, Gothenburg, Sweden

8 Department of Women’s and Children’s Health, Karolinska Institutet, Stockholm, Sweden

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BMC Pregnancy and Childbirth 2014, 14:179  doi:10.1186/1471-2393-14-179

Published: 29 May 2014

Abstract

Background

There 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.

Methods

The 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.

Results

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%. The proportion of emergency transfers varied from 0% to 5.4%.

Conclusion

Future studies should report indications for transfer from home to hospital and provide clear definitions of emergency transfers.

Keywords:
Planned home birth; Transfer to hospital; Emergency transfer; Systematic review