Hemförlossningar i Sverige 1992-2005 : Förlossningsutfall och kvinnors erfarenheter
Author: Lindgren, Helena
Date: 2008-05-16
Location: Skandiasalen, Astrid Lindgrens barnsjukhus, Karolinska sjukhuset, Stockholm
Time: 09.00
Department: Institutionen för kvinnors och barns hälsa / Department of Women's and Children's Health
View/ Open:
thesis.pdf (471.1Kb)
Abstract
This is the first national survey of planned home births in Sweden. We
aimed to study women who had given birth or planned to give birth at home
over the period from 1st of January 1992 to 30th of June 2005.
In study I, data from the Swedish Medical Birth Register for the period
1992 to 2001 for 352 women who gave birth outside hospital were compared
with data from 1760 women who had given birth in hospitals. Women who
gave birth at home differed from those who gave birth in the hospital in
various aspects. Women with an out-of-hospital birth had a higher number
of children, a higher level of education but a lower combined family
income and were employed to a lesser degree than those who gave birth in
hospital. The women with an out-of-hospital birth were more frequently
born in a European country other than Sweden but were less frequently
born outside Europe. The prevalence of home birth based on the register
code for out-of-hospital births was 0.38 per thousand births.
In study II, a total of 757 women who had planned a home birth over the
period 1st of January 1992 to 30th of June 2005 were identified through
midwives who assist home deliveries, announcements and through a home
birth association. Of the women who were asked to participate 99 percent
consented. Data were collected through questionnaires. A total of 100
women who had altogether 141 planned home births were not found in the
medical birth register. The prevalence of planned homebirths was 0.95 per
thousand based on data for all women who had been identified through home
birth midwives and announcements and 0.85 per thousand based on register
data for those women. Transfer to hospital during or immediately after
birth occurred in 12.5 percent of planned home births (Study II). The
most common reasons for transfer were slow progress (46%) and the midwife
who had been booked not being available at the onset of labour (14%). One
in four primiparas completed their planned home birth in hospital, the
most common reason for transfer among primiparas being that a different
midwife than the one the woman had seen for check-ups during the
pregnancy assisted at the birth. Factors that influenced transfer were a
previous caesarean section (multiparas) and, for both primiparas and
multiparas, the pregnancy being post-term.
In Study III data from the Swedish Medical Birth Register were compared
for 897 planned homebirths who consented to participate in the study and
have given their personal identity code, and 11,341 hospital births
(control group). The criterion for selection of the control group was
single births in gestational weeks 37-42 with spontaneous onset of
labour. Women who had planned home births more frequently had spontaneous
vaginal deliveries and less frequently serious perineal or vaginal tears.
In study IV, (the same sample as in study II) perceived risks in
connection with place of birth had been considered by three-quarters of
the women. The women dealt with the risk of themselves or their babies
being harmed or dying in the birth through their own preparation,
discussing principally with their partners and home birth midwifes. The
women avoided discussing risks with conventional healthcare staff.
Conclusions: In Sweden, between 1992 and 2005, around 100 women each year
planned a home birth. One out of four primiparas was transferred to
hospital during or immediately after their planned home homebirth and the
total transfer rate was 12.5 percent. The women considered risks
associated with a home birth but avoided discussing them with medical
staff. The neonatal mortality in the home birth group was 2.2 per
thousand compared to 0.6 in the hospital group. Women who planned a home
birth more frequently had a spontaneous vaginal delivery with fewer
serious perineal or vaginal tears after the birth compared to women who
gave birth in the hospital.
List of papers:
I. Hildingsson IM, Lindgren HE, Haglund B, Rådestad IJ (2006). "Characteristics of women giving birth at home in Sweden: a national register study." Am J Obstet Gynecol 195(5): 1366-72. Epub 2006 May 16
Pubmed
II. Lindgren HE, Hildingsson IM, Christensson K, Rådestad IJ (2008). "Transfers in planned home births related to midwife availability and continuity: a nationwide population-based study." Birth 35(1): 9-15
Pubmed
III. Lindgren H, Rådestad I, Christensson K, Hildingsson I (2008). "Outcome of planned home births vs hospital births in Sweden between 1992 and 2004. A population-based register study." (Manuscript)
IV. Lindgren H, Rådestad I, Christensson K, Hildingsson I (2008). "Perceptions of risk and risk management among 735 women who opted for a home birth." (Manuscript)
I. Hildingsson IM, Lindgren HE, Haglund B, Rådestad IJ (2006). "Characteristics of women giving birth at home in Sweden: a national register study." Am J Obstet Gynecol 195(5): 1366-72. Epub 2006 May 16
Pubmed
II. Lindgren HE, Hildingsson IM, Christensson K, Rådestad IJ (2008). "Transfers in planned home births related to midwife availability and continuity: a nationwide population-based study." Birth 35(1): 9-15
Pubmed
III. Lindgren H, Rådestad I, Christensson K, Hildingsson I (2008). "Outcome of planned home births vs hospital births in Sweden between 1992 and 2004. A population-based register study." (Manuscript)
IV. Lindgren H, Rådestad I, Christensson K, Hildingsson I (2008). "Perceptions of risk and risk management among 735 women who opted for a home birth." (Manuscript)
Issue date: 2008-04-25
Rights:
Publication year: 2008
ISBN: 978-91-7357-535-5
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