Home Birth to Hospital Transfers: How Do Prenatal Visits and Stage of Labor at Transfer Affect Outcomes? [26O]

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Abstract

INTRODUCTION:

Approximately 25,000 deliveries in the US last year were home births, and the risk of transport to a hospital during attempted home birth has been reported as 25–37%. We examined whether maternal and neonatal outcomes are affected by cervical dilation at time of transfer or by number of prenatal visits (PNV) with an obstetrician.

METHODS:

This was a retrospective cohort study over years 2012–2014 of women with singleton gestations at term who attempted a home birth and were transferred during labor to our university hospital. Multiple gestations and fetal anomalies were excluded. Number of PNV (<12 versus ≥12 visits as recommended by ACOG), cervical dilation at time of transfer, and several maternal and neonatal outcomes were extracted from an existing perinatal database.

RESULTS:

All women had attended at least 1 PNV. The overall cesarean rate for planned home births was 34.3%, and 10% of women transferred their care at 10 cm. Among women who were 0–5 cm, 6–9 cm, versus 10 cm at transfer, no significant difference in mode of delivery was found. No differences in maternal outcomes (blood transfusion, postpartum infection, hospital stay, readmission, and others) were observed comparing groups by cervical dilation at presentation or by number of PNV. Similarly, neonatal outcomes of Apgars, pH, resuscitation, and disposition did not differ significantly between groups.

CONCLUSION:

Cervical dilation and number of PNV did not affect maternal or neonatal outcomes. Further research is needed to guide prenatal and intra-partum care to improve outcomes for women transferring care to the hospital from an attempted home birth.

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