Transfer in planned home births in Sweden--effects on the experience of birth: a nationwide population-based study.

OBJECTIVE: More than 10% of all planned home births in high-income countries are completed in the hospital. The aim of this study was to compare the birth experiences among women who planned to give birth at home and completed the birth at home and women who were transferred to hospital during or immediately after the birth. METHODS: All women in Sweden who had a planned home birth between 1998 and 2005 (n=671) were invited to participate in the study. The women who agreed to participate received one questionnaire for each planned home birth. Mixed methods were used for the analysis. RESULTS: Women who had been transferred during or immediately after the planned home birth had a more negative birth experience in general. In comparison with women who completed the birth at home, the odds ratio for being less satisfied was 13.5, CI 8.1-22.3. Reasons for being dissatisfied related to organizational factors, the way the women were treated or personal ability. CONCLUSION: Being transferred during a planned home birth negatively affects the birth experience. Treatments as well as organizational factors are considered to be obstacles for a positive birth experience when transfer is needed. Established links between the home birth setting and the hospital might enhance the opportunity for a positive birth experience irrespective of where the birth is completed.

'What is could indeed be better'--Swedish women's perceptions of early postnatal care.

BACKGROUND: studies have shown that women are more likely to be satisfied with intrapartum rather than postpartum care. The structure and organisation of care seems to be a barrier to good-quality postpartum treatment OBJECTIVE: to explore the perceived reality and the subjective importance of early postnatal care provided in hospital, and to study women's satisfaction with different models of early postnatal care and the factors that are most strongly associated with being 'very satisfied' with the postnatal care received. METHOD: a regional survey was conducted with 1240 women recruited in mid-pregnancy and followed-up two months after childbirth. RESULTS: a statistically significant difference existed between the subjective importance and the perceived reality for all studied variables, with a greater subjective importance than perceived reality for all statements. The length of postnatal stay and the content of care were related to satisfaction, while the model of postnatal care was not. The most important variables for being 'very satisfied' with postnatal care were that the infant received the best possible check-ups/medical care, and that the woman received sufficient support from staff. CONCLUSION: further studies are needed to assess the best model of postnatal care that gives the best opportunities to provide satisfactory care for women and their families.

Perceptions of risk and risk management among 735 women who opted for a home birth.

OBJECTIVE: home birth is not included in the Swedish health-care system and the rate for planned home births is less than one in a thousand. The aim of this study was to describe women's perceptions of risk related to childbirth and the strategies for managing these perceived risks. DESIGN AND SETTING: a nationwide study including all women who had given birth at home in Sweden was conducted between 1 January 1992 and 31 July 2005. PARTICIPANTS: a total of 735 women had given birth to 1038 children. Of the 1038 questionnaires sent to the women, 1025 (99%) were returned. MEASUREMENTS: two open questions regarding risk related to childbirth and two questions answered using a scale were investigated by content analysis. FINDINGS: regarding perceived risks about hospital birth, three categories, all related to loss of autonomy, were identified: (1) being in the hands of strangers; (2) being in the hands of routines and unnecessary interventions; and (3) being in the hands of structural conditions. Perceived risks related to a home birth were associated with a sense of being beyond help: (1) worst-case scenario; and (2) distance to the hospital. The perceived risks were managed by using extrovert activities and introvert behaviour, and by avoiding discussions concerning risks with health-care professionals. CONCLUSION: women who plan for a home birth in Sweden do consider risks related to childbirth but they avoid talking about the risks with health-care professionals. IMPLICATIONS FOR PRACTICE: to understand why women choose to give birth at home, health-care professionals must learn about the perceived beneficial effect of doing so.

Outcome of planned home births compared to hospital births in Sweden between 1992 and 2004. A population-based register study.

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. MAIN OUTCOME MEASURES: Prevalence of mortality and morbidity among mothers and children, emergency conditions, instrumental and operative delivery and perineal lacerations were compared. RESULTS: During this period in Sweden the neonatal mortality rate was 2.2 per thousand in the home birth group and 0.7 in the hospital group (RR 3.6, 95% CI 0.2-14.7). No cases of emergency complications were found in the home birth group. 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 cesarean 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. CONCLUSION: In Sweden, between 1992 and 2004, the intrapartum and neonatal mortality in planned home births was 2.2 per thousand. The proportion is higher compared to hospital births but no statistically significant difference was found. Women in the home birth group more often experienced a spontaneous birth without medical intervention and were less likely to sustain pelvic floor injuries.

Transfers in planned home births related to midwife availability and continuity: a nationwide population-based study.

BACKGROUND: Planning a home birth does not necessarily mean that the birth will take place successfully at home. The object of this study was to describe reasons and risk factors for transfer to hospital during or shortly after a planned home birth. METHODS: A nationwide study including all women who had given birth at home in Sweden between January 1, 1992, and July 31, 2005. A total of 735 women had given birth to 1,038 children. One questionnaire for each planned home birth was sent to the women. Of the 1,038 questionnaires, 1,025 were returned. Reasons for transfer and obstetric, socioeconomic, and care-related risk factors for being transferred were measured using logistic regression. RESULTS: Women were transferred in 12.5 percent of the planned home births. Transfers were more common among primiparas compared with multiparas (relative risk [RR] 2.5; 95% CI 1.8-3.5). Failure to progress and unavailability of the chosen midwife at the onset of labor were the reasons for 46 and 14 percent of transfers, respectively. For primiparas, the risk was four times greater if a midwife other than the one who carried out the prenatal checkups assisted at the birth (RR 4.4; 95% CI 2.1-9.5). A pregnancy exceeding 42 weeks increased the risk of transfer for both primiparas (RR 3.0; 95% CI 1.1-9.4) and multiparas (RR 3.4; 95% CI 1.3-9.0). CONCLUSIONS: The most common reasons for transfer to hospital during or shortly after delivery were failure to progress followed by the midwife's unavailability at the onset of labor. Primiparas whose midwife for checkups during pregnancy was different from the one who assisted at the home birth were at increased risk of being transferred.

New parents' experiences of postnatal care in Sweden.

PURPOSE: The aim was to study new parents' satisfaction with postnatal care and to estimate the proportion of fathers who were given the option of spending the night at the postnatal ward. PROCEDURES: A questionnaire was mailed to new parents 6 months after the birth of their child in a Swedish hospital. The main outcome was overall satisfaction with postnatal care. FINDINGS: Two hundred and ninety-four new mothers and 280 new fathers completed the questionnaire. Thirty-four percent of the mothers were dissatisfied with the overall postnatal care. The strongest associated factors for new mothers' dissatisfaction were: unfriendly and unhelpful staff (RR 10.3; 3.2-32), lack of support from staff (RR 6.4; 2.3-17.5), new fathers not permitted to stay overnight (RR 5.2; 1.8-14.5), dissatisfaction with postnatal checks of the woman herself (RR 2.6; 1.1-6.3) and dissatisfaction with practical breast-feeding support (RR 1.6; 1.2-2.1). Sixty-three percent of the fathers were given the option of spending the night at the postnatal ward. The fathers who chose not to spend the night on the ward were older, had other children and were dissatisfied that they were not allowed to play a greater role in the care of their newborn baby. MAIN CONCLUSIONS: In order to increase patient satisfaction, the needs of the new family must be highlighted and more support and help provided to new parents on the postnatal ward. It is essential to have family oriented postnatal care and to give fathers the opportunity to stay overnight and involve them in the care of their newborn baby.

Characteristics of women giving birth at home in Sweden: a national register study.

OBJECTIVE: The objective of the study was to estimate the proportion of planned home births in Sweden and to identify maternal characteristics of women giving birth at home. STUDY DESIGN: This case-control study included register data of births from 1992 to 2001 in 352 women giving birth at home and 1760 women giving birth in a hospital. RESULTS: Four hundred thirty-nine out-of-hospital births were found during the study period, and the proportion of planned home births was less than 0.5/1000. Women with home birth were more likely to have 4 children or more (odds ratio 3.7 [1.4 to 9.9]), be born in a European country outside Sweden (odds ratio 3.5 [1.8 to 6.8]), have a family income below the median (odds ratio 2.9 [2.0 to 4.1]), not work outside the home (odds ratio 2.4 [1.7 to 3.5]), have a high level of education (odds ratio 2.1 [1.5 to 3.0]), and be older than 35 years (odds ratio 1.7 [1.1 to 2.5]). CONCLUSION: Women with planned home births appear to be a group having a different lifestyle, compared with Swedish women in general.