Abstract
Introduction
Home births and births in midwife-led units and the associated potential risks are
still
being debated. An analysis of the quality of results of planned home births and births
in
midwife-led units which require intrapartum transfer of the mother to hospital provides
important information on the quality of processes during births which occur outside
hospital
settings. The aim of this study was to analyze neonatal and maternal outcomes after
the
initial plan to deliver at home or in a midwife-led unit had to be abandoned and the
mother
transferred to hospital.
Material and Methods
The method used was an analysis of data obtained from the Austrian Birth Registry.
The
dataset consisted of singleton term pregnancies delivered in the period from 1 January
2017
to 31 December 2021 (n = 286056). For the analysis, two groups were created for comparison
(planned hospital births and hospital births recorded in the Registry as births originally
planned as home births or births in midwife-led units but which required a transfer
to
hospital) and assessed with regard to previously defined variables. Data were analyzed
using
frequency description, bivariate analysis and regression models.
Results
In Austria, an average of 19% of planned home births have to be discontinued and the
mother transferred to hospital. Home births and births in midwife-led units which
require
transfer of the mother to hospital are associated with higher intervention rates
intrapartum, high rates of vacuum delivery, and higher emergency c-section rates compared
to
planned hospital births. Multifactorial regression analysis showed significantly higher
risks of poorer scores for all neonatal outcome parameters (Apgar score, pH value,
transfer
rate).
Conclusion
If a birth which was planned as a home delivery or as a delivery in a midwife-led
unit
fails to progress because of (possible) anomalies, the midwife must respond and transfer
the
mother to hospital. This leads to a higher percentage of clinical interventions occurring
in
hospital. From the perspective of clinical obstetrics, it is understandable, based
on the
existing data, that giving birth outside a clinical setting cannot be recommended.
Keywords
obstetrics - home birth - midwife-led unit - neonatal outcomes
