Contraindications in planned home birth in Iceland: A retrospective cohort study

摘要

Highlights ? Current evidence on risk is insufficient for defining home birth contraindications. ? Knowledge on contraindications in different birth settings adds valuable new evidence. ? The presence of contraindications increases risk, compared to no contraindications. ? In contraindicated births, planning a home birth increases risk, compared to hospital. ? Among healthy women, planning a hospital birth increases risk, compared to home birth. Abstract Objectives Icelandic national guidelines on place of birth list contraindications for home birth. Few studies have examined the effect of contraindication on home birth, and none have done so in Iceland. The aim of this study was to examine whether contraindications affect the outcome of planned home birth or have a different effect at home than in hospital. Methods The study is a retrospective cohort study on the effect of contraindications for home birth on the outcome of planned home ( n ?=?307) and hospital ( n ?=?921) birth in 2005–2009. Outcomes were described for four different groups of women, by exposure to contraindications (unexposed vs. exposed) and planned place of birth (hospital vs. home). Linear and logistic regression analysis was used to evaluate the effect of the contraindications under study and to detect interactions between contraindications and planned place of birth. Results The key findings of the study were that contraindications were related to higher rates of adverse maternal and neonatal outcomes, regardless of place of birth; women exposed to contraindications had higher rates of adverse outcomes in planned home birth; and healthy, unexposed women had higher rates of adverse outcomes in planned hospital birth. Contraindications significantly increased the risk of transfer in labour and postpartum haemorrhage in planned home births. Conclusion The defined contraindications for home birth had a negative effect on maternal and neonatal outcomes in Iceland, regardless of place of birth. The study results do not contradict the current national guidelines on place of birth.