Vol 94, No 7 (2023)
Research paper
Published online: 2023-01-13

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Complications of planned home births in the Czech Republic

Petr Krepelka12, Hynek Herman12, Petr Velebil12, Alena Mechurova12, Jiri Hanacek12, Zbynek Stranak12, Jaroslav Feyereisl12
Pubmed: 36929793
Ginekol Pol 2023;94(7):552-558.

Abstract

Objectives: This study evaluated complications that can occur during planned home births that require transfer to the hospital. These factors were assessed to improve the current status of deliveries performed outside health care facilities in the Czech Republic.

Material and methods: This prospective cohort study included data on 105 cases of complicated home births during 2017 to 2021 using an online form accessible to all hospital maternity wards in the Czech Republic.

Results: Planned home births were complicated by fetal/neonatal causes, maternal causes, and combined fetomaternal complications in 28 (26.7%), 20 (19%), and 2 (1.9%) cases, respectively. The need for transfer was most often realized after the birth of the fetus (86; 81.9%); however, it was realized during birth in 19 (18.1%) cases. The following complications were noted most often: postpartum hemorrhage (23; 21.9%); neonatal asphyxia (17; 16.2); placental retention (14; 13.3%); birth injury (12; 11.4%); neonatal hypothermia (5; 4.8%); and placental birth (5; 4.8%). Indications for transfer during labor were as follows: labor obstruction (10; 9.5%); fetal hypoxia (5; 4.8%); bleeding during labor (2; 1.9%); preeclampsia (1; 0.9%); and fetal malformation (1; 0.9%). Perinatal death occurred in 8 (7.6%) cases. Permanent neonatal morbidity occurred in 4 (3.8%) cases.

Conclusions: Patients with home birth complications were transferred to the hospital most often after the birth of the fetus. The low proportion of transfers during childbirth is caused by the unprofessional management of planned home births, resulting in a high number of perinatal deaths and high rate of permanent neonatal morbidity.

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References

  1. Keirse MJ. Home birth: gone away, gone astray, and here to stay. Birth. 2010; 37(4): 341–346.
  2. Chervenak FA, McCullough LB, Grünebaum A, et al. Planned home birth in the United States and professionalism: a critical assessment. J Clin Ethics. 2013; 24(3): 184–191.
  3. Zielinski R, Ackerson K, Kane Low L. Planned home birth: benefits, risks, and opportunities. Int J Womens Health. 2015; 7: 361–377.
  4. Nove A, Berrington A, Matthews Z. Comparing the odds of postpartum haemorrhage in planned home birth against planned hospital birth: results of an observational study of over 500,000 maternities in the UK. BMC Pregnancy Childbirth. 2012; 12: 130.
  5. Davis D, Baddock S, Pairman S, et al. Planned place of birth in New Zealand: does it affect mode of birth and intervention rates among low-risk women? Birth. 2011; 38(2): 111–119.
  6. Johnson KC, Daviss BA. Outcomes of planned home births with certified professional midwives: large prospective study in North America. BMJ. 2005; 330(7505): 1416.
  7. Sjöblom I, Nordström B, Edberg AK. A qualitative study of women's experiences of home birth in Sweden. Midwifery. 2006; 22(4): 348–355.
  8. Grünebaum A, McCullough LB, Sapra KJ, et al. Early and total neonatal mortality in relation to birth setting in the United States, 2006-2009. Am J Obstet Gynecol. 2014; 211(4): 390.e1–390.e7.
  9. Wax JR, Lucas FL, Lamont M, et al. Maternal and newborn outcomes in planned home birth vs planned hospital births: a metaanalysis. Am J Obstet Gynecol. 2010; 203(3): 243.e1–243.e8.
  10. Grünebaum A, McCullough LB, Sapra KJ, et al. Apgar score of 0 at 5 minutes and neonatal seizures or serious neurologic dysfunction in relation to birth setting. Am J Obstet Gynecol. 2013; 209(4): 323.e1–323.e6.
  11. Snowden JM, Tilden EL, Snyder J, et al. Planned out-of-hospital birth and birth outcomes. N Engl J Med. 2015; 373(27): 2642–2653.
  12. Cheng YW, Snowden JM, King TL, et al. Selected perinatal outcomes associated with planned home births in the United States. Am J Obstet Gynecol. 2013; 209(4): 325.e1–325.e8.
  13. Chang JJ, Macones GA. Birth outcomes of planned home births in Missouri: a population-based study. Am J Perinatol. 2011; 28(7): 529–536.
  14. Malloy MH. Infant outcomes of certified nurse midwife attended home births: United States 2000 to 2004. J Perinatol. 2010; 30(9): 622–627.
  15. Cheyney M, Bovbjerg M, Everson C, et al. Outcomes of care for 16,924 planned home births in the United States: the Midwives Alliance of North America Statistics Project, 2004 to 2009. J Midwifery Womens Health. 2014; 59(1): 17–27.
  16. National Collaborating Centre for Women's and Children's Health (UK). Intrapartum Care: Care of Healthy Women and Their Babies During Childbirth. RCOG Press, London 2004.
  17. National Maternity Registry. Prague: Institute of Health Information and Statistics of the Czech Republic 2020. http://eregpublic.ksrzis.cz/cms/web/NZIS/Stranky/NRROD.aspx (20.01.2022).
  18. National Newborn Register Prague: Institute of Health Information and Statistics of the Czech Republic 2020. http://eregpublic.ksrzis.cz/cms/web/NZIS/Stranky/NRNAR.aspx (20.01.2022).
  19. Collaborative survey of perinatal loss in planned and unplanned home births. Northern Region Perinatal Mortality Survey Coordinating Group. BMJ. 1996; 313(7068): 1306–1309.
  20. Committee on Obstetric Practice. Committee opinion no 697: planned home birth. Obstet Gynecol. 2017; 129(4): e117–e122.
  21. Křepelka P, Velebil P, Měchurová A, et al. Complications of planned home births in the Czech Republic between 2016‒2017. Cent Eur J Public Health. 2020; 28(3): 230–236.
  22. Blix E, Kumle M, Kjærgaard H, et al. Transfer to hospital in planned home births: a systematic review. BMC Pregnancy Childbirth. 2014; 14: 179.
  23. Blix E, Kumle MH, Ingversen K, et al. Transfers to hospital in planned home birth in four Nordic countries - a prospective cohort study. Acta Obstet Gynecol Scand. 2016; 95(4): 420–428.
  24. Endrich O, Rimle C, Zwahlen M, et al. Asphyxia in the Newborn: Evaluating the Accuracy of ICD Coding, Clinical Diagnosis and Reimbursement: Observational Study at a Swiss Tertiary Care Center on Routinely Collected Health Data from 2012-2015. PLoS One. 2017; 12(1): e0170691.
  25. Aziz K, Lee CH, Escobedo MB, et al. Part 5: Neonatal Resuscitation: 2020 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Pediatrics. 2021; 147(Suppl 1): e2020038505E.
  26. Reale SC, Easter SR, Xu X, et al. Trends in Postpartum Hemorrhage in the United States From 2010 to 2014. Anesth Analg. 2020; 130(5): e119–e122.
  27. Deneux-Tharaux C, Bonnet MP, Tort J. [Epidemiology of post-partum haemorrhage]. J Gynecol Obstet Biol Reprod (Paris). 2014; 43(10): 936–950.
  28. Cheung WMC, Hawkes A, Ibish S, et al. The retained placenta: historical and geographical rate variations. J Obstet Gynaecol. 2011; 31(1): 37–42.
  29. Adatara P, Strumpher J, Ricks E. Exploring the reasons why women prefer to give birth at home in rural northern Ghana: a qualitative study. BMC Pregnancy Childbirth. 2020; 20(1): 500.