Background
Methods
Study design
Study population
Definition of variables
Potential confounders
Data analysis
Results
Participants
Planned place of birth | ||||||
---|---|---|---|---|---|---|
Nulliparous women (N = 1585) | Parous women (N = 1910) | |||||
Home birth (N = 868) N(%) | Hospital birth (N = 717) N(%) |
P-value | Home birth (N = 1182) N(%) | Hospital birth (N = 728) N(%) |
P-value | |
Maternal age, years | ||||||
< 25 | 145 (16.7) | 131 (18.3) | 0.002* | 48 (4.1) | 36 (4.9) | 0.148 |
25–35 | 651 (75.0) | 490 (68.3) | 870 (73.6) | 506 (69.5) | ||
≥ 35 | 72 (8.3) | 96 (13.4) | 264 (22.3) | 186 (25.5) | ||
Gestational age at birth, weeks | ||||||
37 + 0–37 + 6 | 35 (4.0) | 33 (4.6) | 0.201 | 27 (2.3) | 14 (1.9) | 0.856 |
38 + 0–40 + 6 | 641(73.8) | 551 (76.8) | 934 (79.0) | 575 (79.0) | ||
41 + 0–41 + 6 | 192 (22.1) | 133 (18.5) | 221 (18.7) | 139 (19.1) | ||
Ethnic background | ||||||
Dutch background | 785 (90.4) | 540 (75.3) | <0.001* | 1030 (87.1) | 532 (73.1) | <0.001* |
Non-Dutch Western background | 37 (4.3) | 82 (11.4) | 82 (6.9) | 69 (9.5) | ||
Non-Western background | 43 (5.0) | 92 (12.8) | 65 (5.5) | 125 (17.2) | ||
Missing | 3 (0.3) | 3 (0.4) | 5 (0.4) | 2 (0.3) | ||
Prepregnancy BMI | ||||||
< 25.0 | 654 (75.3) | 511 (71.3) | 0.146 | 842 (71.2) | 481 (66.1) | 0.051 |
≥ 25.0 | 182 (21.0) | 170 (23.7) | 292 (24.7) | 216 (29.7) | ||
Missing | 32 (3.7) | 36 (5.0) | 48 (4.1) | 31 (4.3) | ||
Socioeconomic position | ||||||
High | 187 (21.5) | 180 (25.1) | 0.181 | 321 (27.2) | 205 (28.2) | 0.137 |
Middle | 389 (44.8) | 319 (44.5) | 581 (49.2) | 325 (44.6) | ||
Low | 288 (33.2) | 215 (30.0) | 277 (23.4) | 194 (26.6) | ||
Missing | 4 (0.5) | 3 (0.4) | 3 (0.3) | 4 (0.5) | ||
Birth weight | ||||||
< 2500 | 8 (0.9) | 9 (1.3) | 0.553 | 3 (0.3) | 0 | 0.053 |
2500–2999 | 88 (10.1) | 79 (11.0) | 49 (4.1) | 51 (7.0) | ||
3000–3499 | 351 (40.4) | 312 (43.5) | 373 (31.6) | 220 (30.2) | ||
3500–3999 | 311 (35.8) | 238 (33.2) | 471 (39.8) | 287 (39.4) | ||
≥ 4000 | 104 (12.0) | 76 (10.6) | 286 (24.2) | 169 (23.2) | ||
Missing | 6 (0.7) | 3 (0.4) | 0 | 1 (0.1) | ||
Instrumental vaginal birth in obstetric history | ||||||
Yes | 98 (8.3) | 116 (15.9) | <0,001* |
Obstetric interventions and maternal outcomes
Nulliparous (n = 1585) | Parous (n = 1910) | |||||||
---|---|---|---|---|---|---|---|---|
No of events/births | Incidence (%) | Crude OR (95 % CI) | Adjusted OR (95 % CI)a
| No of events/births | Incidence (%) | Crude OR (95 % CI) | Adjusted OR (95 % CI)a
| |
Spontaneous birth | ||||||||
Planned home birth | 651/868 | 75.0 | 1.31 (1.05–1.65)* | 1.38 (1.08–1.76)* | 1164/1182 | 98.5 | 2.30 (1.25–4.25)* | 2.29 (1.21–4.36)* |
Planned hospital birth | 498/717 | 69.5 | 1 | 1 | 703/728 | 96.6 | 1 | 1 |
Vacuum/forceps birth c
| ||||||||
Planned home birth | 156/868 | 18.0 | 0.83 (0.64–1.06) | 0.77 (0.60–1.01) | 11/1182 | 0.9 | 0.52 (0.23–1.16) | 0.46 (0.20–1.07)b
|
Planned hospital birth | 150/717 | 20.9 | 1 | 1 | 13/728 | 1.8 | 1 | 1 |
Unplanned caesarean section | ||||||||
Planned home birth | 61/868 | 7.0 | 0.74 (0.51–1.07) | 0.72 (0.48–1.09) | 7/1182 | 0.6 | 0.35 (0.14–0.91)* | 0.42 (0.16–1.10)b
|
Planned hospital birth | 69/717 | 9.6 | 1 | 1 | 12/728 | 1.7 | 1 | 1 |
Episiotomy | ||||||||
Planned home birth | 319/856 | 37.3 | 0.81 (0.65–1.00) | 0.73 (0.58–0.91)* | 74/1182 | 6.3 | 0.49 (0.35–0.69)* | 0.47 (0.33–0.68)* |
Planned hospital birth | 299/713 | 41.9 | 1 | 1 | 89/727 | 12.2 | 1 | 1 |
Labour augmentation: oxytocin | ||||||||
Planned home birth | 208/868 | 24.0 | 0.77 (0.60–0.99)* | 0.81 (0.62–1.05) | 50/1182 | 4.2 | 0.49 (0.33–0.73)* | 0.55 (0.36–0.82)* |
Planned hospital birth | 202/717 | 28.2 | 1 | 1 | 60/728 | 8.2 | 1 | 1 |
Use of oxytocin in the third stage of labour | ||||||||
Planned home birth | 694/857 | 81.0 | 0.62 (0.45–0.84)* | 0.58 (0.42–0.80)* | 739/1181 | 62.6 | 0.45 (0.36–0.57)* | 0.47 (0.37–0.60)* |
Planned hospital birth | 616/713 | 86.4 | 1 | 1 | 549/727 | 75.5 | 1 | 1 |
Maternal outcomes | ||||||||
Intact perineum | ||||||||
Planned home birth | 220/856 | 25.7 | 0.87 (0.69–1.11) | 0.91 (0.71–1.18) | 575/1182 | 48.7 | 1.55 (1.28–1.89)* | 1.65 (1.34–2.03)* |
Planned hospital birth | 210/713 | 29.5 | 1 | 1 | 285/727 | 39.2 | 1 | 1 |
Anal sphincter damage (third-or fourth degree) | ||||||||
Planned home birth | 45/856 | 5.3 | 1.67 (0.99–2.81) | 1.75 (1.01–3.03)*b
| 17/1182 | 1.4 | 0.74 (0.36–1.52) | 0.73 (0.34–1.58)b
|
Planned hospital birth | 23/713 | 3.2 | 1 | 1 | 14/727 | 1.9 | 1 | 1 |
Haemorrhage postpartum >1000 ml | ||||||||
Planned home birth | 65/847 | 7.7 | 1.21 (0.81–1.82) | 1.03 (0.67–1.59) | 28/1180 | 2.4 | 0.67 (0.38–1.19) | 0.68 (0.38–1.23)b
|
Planned hospital birth | 46/708 | 6.5 | 1 | 1 | 24/725 | 3.3 | 1 | 1 |
Labour process
Nulliparous (n = 1585) | Parous (n = 1910) | |||||||
---|---|---|---|---|---|---|---|---|
No of events/Births | Incidence (%) | Crude OR (95 % CI) | Adjusted OR (95 % CI) a
| No of events/births | Incidence (%) | Crude OR (95 % CI) | Adjusted OR (95 % CI) a
| |
Duration first stage: < 6 h | ||||||||
Planned home birth | 213/825 | 25.8 | 0.99 (0.78–1.27) | 0.99 (0.76–1.28) | 944/1173 | 80.5 | 1.89 (1.52–2.35)* | 1.74 (1.38–2.19)* |
Planned hospital birth | 173/693 | 25.0 | 1 | 1 | 496/724 | 68.5 | 1 | 1 |
Duration first stage: > 12 h | ||||||||
Planned home birth | 213/825 | 25.8 | 0.85 (0.68–1.08) | 0.86 (0.67–1.11) | 26/1173 | 2.2 | 0.64 (0.36–1.12) | 0.69 (0.38–1.25)b
|
Planned hospital birth | 204/693 | 29.4 | 1 | 1 | 26/724 | 3.6 | 1 | 1 |
Duration second stage nulliparous women: ≥ 90 min | ||||||||
Planned home birth | 179/803 | 21.2 | 1.57 (1.18–2.09)* | 1.38 (1.03–1.1.86)* | ||||
Planned hospital birth | 94/661 | 14.2 | 1 | 1 | ||||
Duration second stage parous women: ≥ 30 min | ||||||||
Planned home birth | 95/1175 | 8.1 | 0.69 (0.50–0.95)* | 0.65 (0.47–0.91)* | ||||
Planned hospital birth | 83/715 | 11.6 | 1 | 1 | ||||
Position during childbirth: non- recumbentc
| ||||||||
Planned home birth | 98/579 | 16.9 | 1.85 (1.22–2.80)* | 1.98 (1.27–3.10)* | 138/792 | 17.7 | 1.47 (1.03–2.09)* | 1.56 (1.08–2.25)* |
Planned hospital birth | 45/415 | 10,8 | 1 | 1 | 55/417 | 13.4 | 1 | 1 |
Use of pharmacological pain reliefc/d
| ||||||||
Planned home birth | 139/584 | 23.8 | 0.54 (0.40–72)* | 0.53 (0.39–0.72)* | 11/800 | 1.4 | 0.13 (0.07–0.26)* | 0.15 (0.07–0.30)*b
|
Planned hospital birth | 151/418 | 36.1 | 1 | 1 | 40/421 | 9.5 | 1 | 1 |
Transfer of care to obstetrician during labour or directly postpartum | ||||||||
Planned home birth | 509/868 | 58.6 | 0.60 (0.48–0.74)* | 0.57 (0.45–0.72)* | 173/1182 | 14.6 | 0.36 (0.28–0.45)* | 0.39 (0.31–0.49)* |
Planned hospital birth | 499/717 | 69.6 | 1 | 1 | 236/728 | 32.4 | 1 | 1 |
Transfer of care to obstetrician during first stage of labour | ||||||||
Planned home birth | 310/868 | 35.7 | 0.51 (0.41–0.63)* | 0.54 (0.43–0.68)* | 110/1182 | 9.3 | 0.29 (0.23–0.38)* | 0.32 (0.24–0.42)* |
Planned hospital birth | 365/717 | 50.9 | 1 | 1 | 188/728 | 25.8 | 1 | 1 |
Transfer of care to obstetrician during second stage of labour | ||||||||
Planned home birth | 141/868 | 16.2 | 1.11 (0.84–1.45) | 0.94 (0.70–1.25) | 17/1182 | 1.4 | 0.62 (0.31–1.23) | 0.63 (0.31–1.30)b
|
Planned hospital birth | 107/717 | 14.9 | 1 | 1 | 17/728 | 2.3 | 1 | 1 |
Transfer of care to obstetrician directly postpartum | ||||||||
Planned home birth | 58/868 | 6.7 | 1.62 (1.02–2.58)* | 1.70 (1.05–2.77)*b
| 46/1182 | 3.9 | 0.90 (0.56–1.45) | 0.96 (0.58–1.57)b
|
Planned hospital birth | 27/717 | 3.8 | 1 | 1 | 31/728 | 4.3 | 1 | 1 |