Outcome of Planned Home and Hospital Births among Low-Risk Women in Iceland in 2005-2009: A Retrospective Cohort Study

• Published in: Birth (Berkeley, Calif.) Vol. 42; no. 1; pp. 16 - 26
• Main Authors: Halfdansdottir, Berglind, Smarason, Alexander Kr, Olafsdottir, Olof A., Hildingsson, Ingegerd, Sveinsdottir, Herdis
• Format: Journal Article
• Language: English
• Published: United States Blackwell Publishing Ltd 01-03-2015; Wiley Subscription Services, Inc
• Subjects: Adult; Births; Childbirth & labor; Cohort Studies; Delivery, Obstetric - adverse effects; Delivery, Obstetric - methods; Delivery, Obstetric - statistics & numerical data; Female; Home Childbirth - adverse effects; Home Childbirth - statistics & numerical data; Hospitalization; Hospitals; Houses; Humans; Iceland; Infant, Newborn; Linear Models; Logistic Models; Male; Midwifery; Obstetric Labor Complications - etiology; Outcome; Planned home birth; Planned hospital birth; Pregnancy; Pregnancy Outcome; Regression analysis; Retrospective Studies; Risk; Variables; Iceland; planned home birth; planned hospital birth; midwifery; outcome
• ISSN: 0730-7659; 1523-536X; 1523-536X
• DOI: 10.1111/birt.12150

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.