Helena Lindgren
Abstract
Objective
The aim of this population based study was to measure the risk of adverse outcome for mother and child in planned home births in a Swedish population, irrespective of where the birth actually occurred, at home or in hospital after transfer.
Design
A population based study using data from the Swedish Medical Birth Register.
Setting
Sweden 1992-2004.
Participants
A total of 897 planned home births were compared with a randomly selected group of 11 341 planned hospital births. We also compared mortality rates with a national sample of 1�122�250 singleton, full-term babies.
Main outcome measures
Prevalence of intrapartum and neonatal mortality (lethal congenital anomalies removed) and morbidity among mothers and children, emergency conditions, instrumental and operative delivery and perineal lacerations were compared.
Results
During this period in Sweden the intrapartum and neonatal mortality rate was 1.1 deaths per thousand (based on 1 death) in the home birth group and 0.35/1,000 in the hospital group and 1.2 deaths per 1000 in the national sample. Almost one in five of the home births had no skilled birth attendant, ten percent were complicated pregnancies. The risk of having a sphincter rupture was lower in the planned home birth group (RR 0.2, 95% CI 0.0-0.7). The risk of having a caesarean section (RR 0.4, 95% CI 0.2-0.7) or instrumental delivery (RR 0.3, 95% CI 0.2-0.5) was significantly lower in the planned home birth group. Women in the home birth group more often experienced a spontaneous birth without medical intervention and were less likely to sustain pelvic floor injuries.
Conclusion
In Sweden, between 1992 and 2004, the intrapartum and neonatal mortality in planned home births was higher compared with the hospital group but similar to most other home birth studies in high resource countries. There were an unusually high percentage of births with no skilled attendant.