Systematic review of women's experiences of planning home birth in consultation with maternity care providers in middle to high-income countries.

AIM: To synthesise findings from published studies, which reported on women's experiences of planning a home birth in consultation with maternity care providers. DESIGN: Systematic Review DATA SOURCES: We searched seven bibliographic databases, (Ovid Medline, Embase, PsycInfo, CINAHL plus, Scopus, ProQuest and Cochrane (Central and Library), from January 2015 to 29th April 2022. REVIEW METHODS: Primary studies were included if they investigated women's experiences of planning a home birth with maternity care providers, in upper-middle and high-income countries and written in English language. Studies were analysed using thematic synthesis. GRADE-CERQual was used to assess the quality, coherence, adequacy and relevance of data. The protocol is registered on PROSPERO registration ID: CRD 42018095042 (updated 28th September 2020) and published. RESULTS: 1274 articles were retrieved, and 410 duplicates removed. Following screening and quality appraisal, 20 eligible studies (19 qualitative and 1 survey) involving 2,145 women were included. KEY CONCLUSIONS: Women's prior traumatic experience of hospital birth and a preference for physiological birth motivated their assertive decision to have a planned home birth despite criticisms and stigmatisation from their social circle and some maternity care providers. Midwives' competence and support enhanced women's confidence and positive experiences of planning a home birth. IMPLICATIONS FOR PRACTICE: This review highlights the stigma that some women feel and the importance of support from health professionals, particularly midwives when planning a home birth. We recommend accessible evidence-based information for women and their families to support women's decision-making for planned home birth. The findings from this review can be used to inform woman-centred planned home birth services, particularly in the UK, (although evidence is drawn from papers in eight other countries, so findings are relevant elsewhere), which will impact positively on the experiences of women who are planning home birth.

Women and maternity care providers experiences of planned home birth in Northern Ireland: A descriptive survey.

BACKGROUND: Where a woman gives birth impacts both her postnatal outcomes and experiences. However, for women who plan home birth in Northern Ireland, their experiences and that of their maternity care providers are rarely sought. AIM: This study examined women's and maternity care providers' experiences and perceptions of home birth service provision in Northern Ireland. METHODS: Online surveys were used to investigate the experiences of women (n = 62) who had experienced a home birth or had a view on planned home birth and maternity care providers (n = 77) who offered home birth services in Northern Ireland between November 2018 and November 2020. The surveys were analysed using descriptive statistics. FINDINGS: The women were all multigravida, with 39 experiencing a planned home birth and three having an intrapartum transfer. Most of the women (61.3 %; n = 38/62) knew about home birth services through social media or friends and 91% (n = 57/62) discussed their plans for home birth with their maternity care providers antenatally. Maternity care providers were mostly supportive (64.9 %; n = 50/77) of women having a choice about place of birth. Midwives were mostly confident (52 %; n = 13/25) or very confident (28 %; n = 7) about caring for women having a planned home birth but did not always feel supported by colleagues. DISCUSSION: Most women rated their care as excellent or very good. Midwives reported limited support from colleagues for home birth provision. CONCLUSION: There is a need to support women in their birthplace choice and empower maternity care providers to facilitate this through a fully resourced home birth service infrastructure and collegial support.

Adaptation and validation of the Portuguese version of the provider attitudes towards planned home birth (PAPHB) Scale.

Maternity health care professionals' attitudes on the option of home birth can influence the choices and decisions women and their partners make about place of birth. Midwives are particularly influential in this space. The study outlined in this paper aimed to translate and validate the Provider Attitudes towards Planned Home Birth (PAPHB) scale questionnaire for use in the Portuguese maternity context. METHODS: A total of 118 Portuguese midwives were selected through intentional sampling. The procedure was divided into two phases. In the first phase, a triple translation from the original language into Portuguese and a cross-cultural adaptation of the Provider Attitudes towards Planned Home Birth (PAPHB) scale were carried out, obtaining three versions of the same questionnaire. The second phase consisted of the validation of the questionnaire, for which the Provider Attitudes towards Planned Home Birth (PAPHB) scale was submitted to a panel of 20 experts and to a pilot test. Subsequently, the reliability and statistical validity of the scale were evaluated. RESULTS: After content analysis, the results confirmed a four-dimensional structure with a Cronbach's α value of 0.933 for the Provider Attitudes towards Planned Home Birth (PAPHB) scale as a whole, showing good internal consistency. Finally, a bivariate analysis was carried out identifying associations between variables and midwives' attitudes towards home birth. Positive attitudes towards homebirth were strongly influenced by previous clinical experience and exposure to home birth during midwives' academic education. CONCLUSION: The 18-item scale is a reliable and valid tool to quantify attitudes towards planned home births in Portugal as the results obtained in the study showed very good internal consistency.

La seguridad del parto planificado en casa: algunas consideraciones a partir de un estudio cualitativo / A segurança do parto domiciliar planejado: algumas considerações de um estudo qualitativo / The safety of planned home birth: some considerations from a qualitative study

Introduction: The search for safety also involves risks caused by the devices that arecreated to anticipate and control them. This is the case of unnecessary interventionism in hospitalbirths in relation to planned home deliveries. Objectives: To explore the relationship betweenphysiological delivery and obstetric interventionism, and to examine the debate on the safety ofhome delivery and its main repercussions. Methodology: Qualitative research. Collection ofinformation with a questionnaire of open questions completed in writing by 45 women who gave226Cultura de los Cuidados. 1º Cuatrimestre 2022. Año XXVI. nº 62birth at home in the province of Murcia between 2008 and 2017. For its analysis MAXQDAqualitative data analysis software was used. Results: obstetric interventionism hinders thephysiological delivery process; The debate over the safety of planned home birth is polarized,causing various repercussions for those involved. Conclusions: planned home birth in low-riskwomen favors the development of physiological delivery, which avoids many of the unnecessaryobstetric interventions associated in hospitals; Likewise, the polarized debate on the safety ofchildbirth at home does not provide consensual information, which has repercussions on thedifferent positioning of the two health groups that take care of childbirth (gynecologists andmidwives), and on the fact that women who decide to perform the home births are pressurized bymultiple sources (health system, family members, friends ...) that come face to face with therelevant information available to them about home birth and the support of the professional whoaccompanies them in the birth.

Introducción: La búsqueda de la seguridad también comporta riesgos provocados desdelos propios dispositivos que se crean para preverlos y controlarlos. Es el caso del intervencionismoinnecesario en los partos hospitalarios en relación a los partos planificados en el hogar. Objetivos:Explorar la relación entre el parto fisiológico y el intervencionismo obstétrico, y examinar eldebate sobre la seguridad del parto domiciliario y sus principales repercusiones.Metodología: Investigación cualitativa. Recogida de información con cuestionario de preguntasabiertas cumplimentadas por escrito por 45 mujeres que parieron en casa en la provincia deMurcia entre 2008 y 2017. Para su análisis empleamos el software de análisis cualitativo de datosMAXQDA. Resultados: el intervencionismo obstétrico dificulta el proceso del parto fisiológico;el debate de la seguridad del parto planificado en casa está polarizado, provocando diversasrepercusiones para los implicados. Conclusiones: el parto planificado en casa en mujeres de bajoriesgo propicia el desarrollo del parto fisiológico, lo que evita muchas de las intervencionesobstétricas innecesarias vinculadas al ámbito hospitalario; asimismo, el polarizado debate de laseguridad del parto en casa no provee una información consensuada, lo que repercute en eldiferente posicionamiento de los dos colectivos sanitarios que se ocupan del parto (ginecólogos ymatronas), y en que las mujeres que deciden realizar el parto en el hogar reciban múltiplespresiones (sistema sanitario, familiares, amigos…) que se confrontan con la relevanteinformación de que dispone sobre el nacimiento en el hogar y el apoyo del profesional que lasacompaña en el parto.

Introdução: A busca por segurança também envolve riscos causados pelos dispositivoscriados para antecipá-los e controlá-los. É o caso do intervencionismo desnecessário nos partoshospitalares em relação aos partos domiciliares planejados. Objetivos: Explorar a relação entreparto fisiológico e intervencionismo obstétrico e examinar o debate sobre a segurança do partodomiciliar e suas principais repercussões. Metodologia: Pesquisa qualitativa. Recolha deinformação com um questionário de perguntas abertas preenchido por escrito por 45 mulheres227Cultura de los Cuidados. 1º Cuatrimestre 2022. Año XXVI. nº 62que deram à luz em casa na província de Murcia entre 2008 e 2017. Para a sua análise utilizou-seo software de análise de dados qualitativos MAXQDA. Resultados: o intervencionismo obstétricodificulta o processo de parto fisiológico; O debate sobre a segurança do parto domiciliar planejadoé polarizado, causando diversas repercussões para os envolvidos. Conclusões: o parto domiciliarplanejado em mulheres de baixo risco favorece o desenvolvimento do parto fisiológico, o queevita muitas das intervenções obstétricas desnecessárias associadas ao ambiente hospitalar; Damesma forma, o debate polarizado sobre a segurança do parto no domicílio não traz informaçõesconsensuais, o que repercute nos diferentes posicionamentos dos dois grupos de saúde que cuidamdo parto (ginecologistas e parteiras), e no fato de as mulheres decidirem por realizar o partodomiciliar recebe múltiplas pressões (sistema de saúde, familiares, amigos ...) que se deparamcom as informações relevantes de que dispõem sobre o parto domiciliar e com o apoio doprofissional que os acompanha no parto.

Planned Home Birth in Low-Risk Pregnancies in Spain: A Descriptive Study.

Previous studies have shown that planned home birth in low-risk pregnancies is a generally safe option. However nowadays, only 0.5 percent of deliveries have been at home in Spain. This study sought to understand the characteristics of planned home births with qualified healthcare professionals in low-risk pregnancies and their results on maternal and neonatal health in the Balearic Islands. The study followed a retrospective descriptive design to investigate planned home births from 1989 to 2019 (n = 820). Sociodemographic data of women, healthcare professional intervention rates, and maternal/fetal morbidity/mortality results were collected. Statistical analysis of the results was performed using the IBM SPSS Version 25 software package. The results indicated that women with low-risk pregnancies who planned home births with a qualified midwife had a higher probability of spontaneous vaginal birth delivery and positive maternal health results. Furthermore, the risk of hospital transfer was low (10.7%) and the rate of prolonged breastfeeding (>1 year) was extremely high (99%). Moreover, the study showed that planned home births can be generally associated with fetal well-being. The conclusions and implications of this study are that planned home births in low-risk pregnancies attended by qualified midwives in the Balearic Islands achieve positive results in both maternal and newborn health, as well as low rates of obstetric intervention.

All that I need exists within me: A qualitative study of nulliparous Norwegian women's experiences with planned home birth.

OBJECTIVE: The aim of this study was to gain knowledge regarding how Norwegian nulliparous women experience planned home birth and why they choose this route of giving birth. DESIGN: A qualitative approach was used, and the study data were derived from semi-structured individual interviews, which were analysed through systematic text condensation. PARTICIPANTS: Ten Norwegian women aged nineteen to thirty-nine years were interviewed. They had each gone through with a successful planned home birth of their first child within the last two years. These women all resided in the middle, western and eastern areas of Norway. A certified midwife was present throughout the labour and birth, and no transfer to the hospital was necessary. FINDINGS: The following two main themes were identified: 'inner motivation' and 'giving birth in safe surroundings'. The women in this study had a strong inner faith in the normal physiological processes of labour and birth and had educated and prepared themselves carefully for their planned home birth. To be able to enter one's own inner world was considered crucial for labour, and the trusting relationship they had with their midwife made this possible. KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: Planned home birth may be experienced as a very positive occurrence for nulliparous women, and the care those women in this study received contained several elements that can help to promote normal labour and birth at a time in which reducing interventions in maternity care is of importance. Their positive birth experiences gave the women confidence both in their transition to motherhood as well as in other aspects of life.

Neonatal mortality in the United States is related to location of birth (hospital versus home) rather than the type of birth attendant.

BACKGROUND: Planned home births have leveled off in the United States in recent years after a significant rise starting in the mid-2000s. Planned home births in the United States are associated with increased patient-risk profiles. Multiple studies concluded that, compared with hospital births, absolute and relative risks of perinatal mortality and morbidity in US planned home births are significantly increased. OBJECTIVE: To explore the safety of birth in the United States by comparing the neonatal mortality outcomes of 2 locations, hospital birth and home birth, by 4 types of attendants: hospital midwife; certified nurse-midwife at home; direct-entry ("other") midwife at home; and attendant at home not identified, using the most recent US Centers for Disease Control and Prevention natality data on neonatal mortality for planned home births in the United States. Outcomes are presented as absolute risks (neonatal mortality per 10,000 live births) and as relative risks of neonatal mortality (hospital-certified nurse-midwife odds ratio, 1) overall, and for recognized risk factors. STUDY DESIGN: We used the most current US Centers for Disease and Prevention Control Linked Birth and Infant Death Records for 2010-2017 to assess neonatal mortality (neonatal death days 0-27 after birth) for single, term (37+ weeks), normal-weight ( >2499 g) infants for planned home births and hospital births by birth attendants: hospital-certified nurse-midwives, home-certified nurse-midwives, home other midwives (eg, lay or direct-entry midwives), and other home birth attendant not identified. RESULTS: The neonatal mortality for US hospital midwife-attended births was 3.27 per 10,000 live births, 13.66 per 10,000 live births for all planned home births, and 27.98 per 10,000 live births for unintended/unplanned home births. Planned home births attended by direct-entry midwives and by certified nurse-midwives had a significantly elevated absolute and relative neonatal mortality risk compared with certified nurse-midwife-attended hospital births (hospital-certified nurse-midwife: 3.27/10,000 live births odds ratio, 1; home birth direct-entry midwives: neonatal mortality 12.44/10,000 live births, odds ratio, 3.81, 95% confidence interval, 3.12-4.65, P<.0001; home birth-certified nurse-midwife: neonatal mortality 9.48/10,000 live births, odds ratio, 2.90, 95% confidence interval, 2.90; P<.0001). These differences increased further when patients were stratified for recognized risk factors. CONCLUSION: The safety of birth in the United States varies by location and attendant. Compared with US hospital births attended by a certified nurse-midwife, planned US home births for all types of attendants are a less safe setting of birth, especially when recognized risk factors are taken into account. The type of midwife attending US planned home birth appears to have no differential effect on decreasing the absolute and relative risk of neonatal mortality of planned home birth, because the difference in outcomes of US planned home births attended by direct-entry midwives or by certified nurse-midwives is not statistically significant.

Critical appraisal of the proposed defenses for planned home birth.

Two prominent proposed defenses have been offered of planned home birth. The first focuses on the very low absolute risk of planned home birth, which is considered to be safe because it is so low, irrespective of its significantly elevated relative risk. The second invokes an analogy between trial of labor after cesarean delivery and planned home birth. Because trial of labor after cesarean delivery and planned home birth have similar, very low absolute risks and because the former is an acceptable clinical practice, defenders of planned home birth argue that the latter should be considered acceptable. This article presents a critical appraisal of these 2 proposed defenses of planned home birth. Question 1: Are proposed defenses of planned home birth focused on its low absolute risks consistent with the commitment to patient safety? This commitment to patient safety requires the identification of variation in the processes of patient care and reduction of variation when reduction improves outcomes. Relative, as well as absolute, risks therefore must be identified. Compared with hospital midwives, planned home births have a significantly higher relative total neonatal mortality risk of 3.87 (1.26 vs 0.32 per 1000 births; P<.001) and a significantly higher relative risk of 5-minute Apgar score of zero of 18.11 (1.63 vs 0.0/1000 births; P<.001). Planned hospital birth prevents these risks. It follows that planned home birth as a variant in birth setting is not consistent with the commitment to patient safety. Question 2: Is the analogy to trial of labor after cesarean delivery consistent with the philosophic rules of analogic reasoning? The long-established philosophic rules for analogic reasoning require that the 2 cases that are compared are similar in all relevant respects and that all relevant analogies have been considered. The 2 cases are dissimilar because the perinatal risks of planned home births are approximately 3 times higher than trial of labor after cesarean delivery. At least 8 clinical analogies to other situations of very low absolute, but unacceptable, risks are ignored. The clinical implication of the results of this critical appraisal is that obstetricians should respond to expressions of interest in planned home birth based on these proposed defenses with a respectful explanation of the inadequacies, the failure to commit to patient safety, and a recommendation for planned hospital birth.

Birthplace in Australia: Antenatal preparation for the possibility of transfer from planned home birth.

OBJECTIVE: The aim of the study was to explore how women and midwives prepare, during the antenatal period, for the possibility of intrapartum transfer from planned home birth. DESIGN: A Constructivist Grounded Theory approach was taken in order to focus upon the social interactions and processes that emerged. SETTING: Urban and regional areas in four states of south eastern Australia. PARTICIPANTS: Thirty-one semi-structured interviews were conducted with women and midwives. FINDINGS: There were three sub-categories relating to preparation for the possibility of transfer. These were 'Building the midwife-woman partnership', 'Fostering professional connections' and 'Reducing uncertainty'. The reciprocal trust inherent in the midwife-woman partnership helped women feel safe in relation to the possibility of intrapartum transfer to hospital. Midwives who had positive transfer experiences spoke about their commitment to fostering professional connections with hospitals and health professionals as a part of building the capacity for collaboration if, and when, a transfer occurred. Reducing uncertainty involved preparation that included not only providing information and emotional support to the woman around the possibility of transfer, but also arranging for her to book in to a back-up hospital.

Planned home births in the Czech Republic, 2018.

STUDY AIM: A summary of the current situation regarding issues of planned home births in the Czech Republic. TYPE OF STUDY: Review and summarization. Affiliations: Department of Obstetrics and Gynecology of the Liberec regional hospital, and the Department of Obstetrics and Gynecology of the First Faculty of Medicine and General Teaching Hospital in Prague. METHODS: We present a summarization of the available data on the controversial subject of planned home births in the Czech Republic. Planned home births in the Czech Republic are currently the subject of much professional, legal, and ethical discussion. This study also includes a review of the international literature, which describes the influence of planned home births on maternal and perinatal mortality and morbidity. There is as yet no professional organization or legal framework in the Czech Republic for regulating home births, and no precise and dependable data exits on the number, outcomes, or incidence of complications. However, there is an unambiguous consensus among all related specialist organizations in the Czech Medical Association of J. E. Purkyně, which does not support or recommend home births. Despite this, there is a small percentage of women that prefer to give birth at home. Through social networks and public discussion forums that deal with such issues these women find a community that supports and shares, but that also sometimes passes on half-truths and misinformation. Every initially physiological birth can without warning become complicated and require immediate medical intervention. Delays, and inadequate preparation and qualifications can fundamentally influence the further courses and outcomes, complicating the health and life of both mother and child. CONCLUSION: The aim of all specialists participating in any way with this issue should be the spread of indisputable facts based on evidence and warning of the demonstrable risks associated with planned home births.

Mother-newborn separation at birth in hospitals: A possible risk for neurodevelopmental disorders?

In the 20th century, mother-infant separation shortly after birth in hospitals became routine and unique to humans. However, this hospital birth practice is different from the practice in our evolutionary history, where newborn survival depended on close and essentially continuous maternal contact. This time shortly after birth represents a psychophysiologically sensitive or critical period for programming future physiology and behaviour. We hypothesize that early maternal separation as conducted in conventional hospital practice may induce similar epigenetic changes similar to those found in various mental diseases that may also be implicated in neurodevelopmental disorders.

Utah obstetricians' opinions of planned home birth and conflicting NICE/ACOG guidelines: A qualitative study.

BACKGROUND: The United Kingdom's National Institute for Health and Care Excellence (NICE) recently published recommendations that support planned home birth for low-risk women. The American College of Obstetricians and Gynecologists (ACOG) remains wary of planned home birth, asserting that hospitals and birthing centers are the safest birth settings. Our objective was to examine opinions of obstetricians in Salt Lake City, Utah about home birth in the context of rising home birth rates and conflicting guidelines. METHODS: Participants were recruited through online searches of Salt Lake City obstetricians and through snowball sampling. We conducted individual interviews exploring experiences with and attitudes toward planned home birth and the ACOG/NICE guidelines. RESULTS: Fifteen obstetricians who varied according to years of experience, location of medical training, sex, and subspecialty (resident, OB/GYN, maternal-fetal medicine specialist) were interviewed. Participants did not recommend home birth but supported a woman's right to choose her birth setting. Obstetrician opinions about planned home birth were shaped by misconceptions of home birth benefits, confusion surrounding the scope of care at home and among home birth providers, and negative transfer experiences. Participants were unfamiliar with the literature on planned home birth and/or viewed the evidence as unreliable. Support for ACOG guidelines was high, particularly in the context of the United States health care setting. CONCLUSION: Physician objectivity may be limited by biases against home birth, which stem from limited familiarity with published evidence, negative experiences with home-to-hospital transfers, and distrust of home birth providers in a health care system not designed to support home birth.

Planned home birth and the association with neonatal hypoxic ischemic encephalopathy.

OBJECTIVE: To evaluate the association between planned home birth and neonatal hypoxic ischemic encephalopathy (HIE). METHODS: This is a case-control study in which a database of neonates who underwent head cooling for HIE at our institution from 2007 to 2011 was linked to New York City (NYC) vital records. Four normal controls per case were then randomly selected from the birth certificate data after matching for year of birth, geographic location, and gestational age. Demographic and obstetric information was obtained from the vital records for both the cases and controls. Location of birth was analyzed as hospital or out of hospital birth. Details from the out of hospital deliveries were reviewed to determine if the delivery was a planned home birth. Maternal and pregnancy characteristics were examined as covariates and potential confounders. Logistic regression was used to determine the odds of HIE by intended location of delivery. RESULTS: Sixty-nine neonates who underwent head cooling for HIE had available vital record data on their births. The 69 cases were matched to 276 normal controls. After adjusting for pregnancy characteristics and mode of delivery, neonates with HIE had a 44.0-fold [95% confidence interval (CI) 1.7-256.4] odds of having delivered out of hospital, whether unplanned or planned. Infants with HIE had a 21.0-fold (95% CI 1.7-256.4) increase in adjusted odds of having had a planned home birth compared to infants without HIE. CONCLUSION: Out of hospital birth, whether planned home birth or unplanned out of hospital birth, is associated with an increase in the odds of neonatal HIE.

Paramedics׳ involvement in planned home birth: A one-year case study.

OBJECTIVE: to report findings from a study performed prior to the introduction of publicly funded home birth programmes in Victoria, Australia, that investigated the incidence of planned home births attended by paramedics and explored the clinical support they provided as well as the implications for education and practice. METHODS: retrospective data previously collected via an in-field electronic patient care record (VACIS(®)) was provided by a state-wide ambulance service. Cases were identified via a comprehensive filter, manually screened and analysed using SPSS version 19. RESULTS: over a 12-month period paramedics attended 26 intended home births. Eight women were transported in labour, most for failure to progress. Three called the ambulance service and their pre-organised midwife simultaneously. Paramedics were required for a range of complications including post partum haemorrhage, perineal tears and neonatal resuscitation. Procedures performed for mothers included IV therapy and administering pain relief. For infants, paramedics performed intermittent positive pressure ventilation, endotracheal intubation and external cardiac compression. Of the 23 women transferred to hospital, 22 were transported to hospital within 32minutes. CONCLUSIONS: findings highlight that paramedics can provide clinical support, as well as efficient transportation, during perinatal emergencies at planned home births. Cooperative collaboration between ambulance services, privately practising midwives and maternity services to develop guidelines for emergency clinical support and transportation service may minimise risk associated with planned home births. This could also lead to opportunities for interprofessional education between midwives and paramedics.

Transfers to hospital in planned home birth in four Nordic countries - a prospective cohort study.

INTRODUCTION: Women planning a home birth are transferred to hospital in case of complications or elevated risk for adverse outcomes. The aim of the present study was to describe the indications for transfer to hospital in planned home births, and the proportion of cases in which this occurs. MATERIAL AND METHODS: Women in Norway, Sweden, Denmark and Iceland who had opted for, and were accepted for, home birth at the onset of labor, were included in the study. Data from 3068 women, 572 nulliparas and 2446 multiparas, were analyzed for proportion of transfers during labor and within 72 h after birth, indications for transfer, how long before or after birth the transfer started, time from birth to start of transfer, duration and mode of transfer, and whether the transfer was classified as potentially urgent. Analyses were stratified for nulliparity and multiparity. RESULTS: One-third (186/572) of the nulliparas were transferred to hospital, 137 (24.0%) during labor and 49 (8.6%) after the birth. Of the multiparas, 195/2446 (8.0%) were transferred, 118 (4.8%) during labor and 77 (3.2%) after birth. The most common indication for transfers during labor was slow progress. In transfers after birth, postpartum hemorrhage, tears and neonatal respiratory problems were the most common indications. A total of 116 of the 3068 women had transfers classified as potentially urgent. CONCLUSIONS: One-third of all nulliparous and 8.0% of multiparous women were transferred during labor or within 72 h of the birth. The proportion of potentially urgent transfers was 3.8%.

Ethics and professional responsibility: Essential dimensions of planned home birth.

Planned home birth is a paradigmatic case study of the importance of ethics and professionalism in contemporary perinatology. In this article we provide a summary of recent analyses of the Centers for Disease Control database on attendants and birth outcomes in the United States. This summary documents the increased risks of neonatal mortality and morbidity of planned home birth as well as bias in Apgar scoring. We then describe the professional responsibility model of obstetric ethics, which is based on the professional medical ethics of two major figures in the history of medical ethics, Drs. John Gregory of Scotland and Thomas Percival of England. This model emphasizes the identification and careful balancing of the perinatologist's ethical obligations to pregnant, fetal, and neonatal patients. This model stands in sharp contrast to one-dimensional maternal-rights-based reductionist model of obstetric ethics, which is based solely on the pregnant woman's rights. We then identify the implications of the professional responsibility model for the perinatologist's role in directive counseling of women who express an interest in or ask about planned home birth. Perinatologists should explain the evidence of the increased, preventable perinatal risks of planned home birth, recommend against it, and recommend planned hospital birth. Perinatologists have the professional responsibility to create and sustain a strong culture of safety committed to a home-birth-like experience in the hospital. By routinely fulfilling these professional responsibilities perinatologists can help to prevent the documented, increased risks planned home birth.

Why such differing stances? A review of position statements on home birth from professional colleges.

UNLABELLED: Despite low rates of home birth throughout most Western countries, the topic generates considerable debate. This is reflected by the differing positions on home birth adopted by professional colleges representing obstetricians and midwives. We reviewed position statements of midwifery and obstetric colleges in the UK, USA, Australia, New Zealand, and Canada to explore how the same body of research evidence leads to different positions. Aside from a joint statement from the UK we found widely differing stances, reflecting traditional midwifery perspectives of birth as a physiological process versus obstetric perspectives of potential pathology. We feel the differences in position statements are largely the end product of significant confirmatory bias. TWEETABLE ABSTRACT: Review of organisational position on home birth suggests bias in literature interpretation.

Os sentidos do parto domiciliar planejado para mulheres do município de São Paulo, São Paulo / The meanings of planned home birth for women from the municipality of Sao Paulo

No Brasil, o parto domiciliar tem sido associado à falta de recursos econômicos e a dificuldades de acesso aos serviços de saúde, uma vez que 98% dos partos ocorrem em hospitais. Entretanto, nos grandes centros urbanos, onde há maior oferta de leitos obstétricos, mulheres de estratos sociais médios têm escolhido o parto domiciliar planejado. Para compreender os sentidos dessa escolha, realizamos uma pesquisa qualitativa na qual entrevistamos 20 mulheres que tiveram parto domiciliar planejado: 19 mulheres entrevistadas tinham ensino superior completo; 1 delas tinha ensino superior incompleto; e 10 delas tinham históricos de parto hospitalar. A análise das entrevistas possibilitou caracterizar os sentidos da escolha pelo parto domicilicar em quatro categorias: a casa como uma alternativa ao modelo de atenção obstétrica vigente; hospital, um lugar a ser evitado; "Louca não, informada!": repercussões da escolha à margem do sistema de saúde; parto em casa como facilitador do protagonismo das mulheres.

In Brazil, giving birth at home rather than in a hospital has been associated with lack of economical resources and with difficulties in accessing health services once 98% of births occur in hospitals. Although there are more obstetric hospitals in big urban cities, women from middle classes have chosen planned home births. This research discusses the meanings of this choice. A qualitative research was carried out and 20 women who planned and had home births were interviewed: 19 interviewed women had graduated from a university course, 1 of them had not finished her university course; and 10 women had already given birth in hospitals. The analysis of the interviews revealed the meanings of choosing home births which were divided into four categories: home birth as an alternative to the current model of obstetric care; hospital, a place to be avoided; "I am not crazy, I have information about it!": repercussions of home births compared to the health system; home birth plays a role in empowering women.

Outcome of planned home and hospital births among low-risk women in Iceland in 2005-2009: a retrospective cohort study.

BACKGROUND: At 2.2 percent in 2012, the home birth rate in Iceland is the highest in the Nordic countries and has been rising rapidly in the new millennium. The objective of this study was to compare the outcomes of planned home births and planned hospital births in comparable low-risk groups in Iceland. METHODS: The study is a retrospective cohort study comparing the total population of 307 planned home births in Iceland in 2005-2009 to a matched 1:3 sample of 921 planned hospital births. Regression analysis, adjusted for confounding variables, was performed for the primary outcome variables. RESULTS: The rate of oxytocin augmentation, epidural analgesia, and postpartum hemorrhage was significantly lower when labor started as a planned home birth. Differences in the rates of other primary outcome variables were not significant. The home birth group had lower rates of operative birth and obstetric anal sphincter injury. The rate of 5-minute Apgar score < 7 was the same in the home and hospital birth groups, but the home birth group had a higher rate of neonatal intensive care unit admission. Intervention and adverse outcome rates in both study groups, including transfer rates, were higher among primiparas than multiparas. Oxytocin augmentation, epidural analgesia, and postpartum hemorrhage rates were significantly interrelated. CONCLUSIONS: This study adds to the growing body of evidence that suggests that planned home birth for low-risk women is as safe as planned hospital birth.

Home birth constructed as a safe choice in Iceland: A content analysis on Icelandic media.

BACKGROUND: The rate of home birth in Iceland increased from 0.1% in the 90's, to 2.2% in 2012. As the media contributes to the development and public perceptions, engagement and use of health care, it is of interest to explore the media representation of planned home birth in Iceland. OBJECTIVES: The aim of this study was to explore the way in which the constructions of planned home birth are represented in the Icelandic media; the frequency with which planned home birth was discussed and by whom it was discussed; whether the discourse was congruent with practice development in the country; and if so, how such congruency was effected. METHODS: Data from the main newspapers in Iceland published from the beginning of 1990 until the end of 2011 were explored using content analysis. RESULTS: In total, 127 items were summarized and we identified five themes: approach to safety, having a choice, the medicalization of childbirth, the relationship between women and midwives, and the reaction of the pregnant woman's local community. Central in the analysis were the importance of being able to choose a safe place of birth and the need for woman-centred care. CONCLUSION: Overall planned home birth was not discussed with much intensity or frequency, but in general the discussion was shaped by a positive attitude. There was a distinction in the public media discourse among midwives and physicians or obstetricians who do not argue against planned home birth but who nevertheless speak with caution. The pregnant women who chose home birth found their own home to be safe and similar views were identified among women and midwives.