title: Transfers to hospital in planned home birth in four Nordic countries - a prospective cohort study.
abstract: BACKGROUND
  Women planning a home birth are transferred to hospital in case of complications or elevated risk for adverse outcomes. The aim of the present study was to describe the indications for transfer to hospital in planned home births, and the proportion of cases in which this occurs.
  
  
  METHODS
  Women in Norway, Sweden, Denmark and Iceland who had opted for, and were accepted for, home birth at the onset of labor, were included in the study. Data from 3068 women, 572 nulliparas and 2446 multiparas, were analyzed for proportion of transfers during labor and within 72 h after birth, indications for transfer, how long before or after birth the transfer started, time from birth to start of transfer, duration and mode of transfer, and whether the transfer was classified as potentially urgent. Analyses were stratified for nulliparity and multiparity.
  
  
  RESULTS
  One-third (186/572) of the nulliparas were transferred to hospital, 137 (24.0%) during labor and 49 (8.6%) after the birth. Of the multiparas, 195/2446 (8.0%) were transferred, 118 (4.8%) during labor and 77 (3.2%) after birth. The most common indication for transfers during labor was slow progress. In transfers after birth, postpartum hemorrhage, tears and neonatal respiratory problems were the most common indications. A total of 116 of the 3068 women had transfers classified as potentially urgent.
  
  
  CONCLUSIONS
  One-third of all nulliparous and 8.0% of multiparous women were transferred during labor or within 72 h of the birth. The proportion of potentially urgent transfers was 3.8%.
authors.affiliation: Faculty of Health, Oslo and Akershus University College of Applied Science, Oslo, Norway.
authors.forename: Ellen
authors.identifier: http://orcid.org/0000-0001-7971-4580
authors.initials: E
authors.lastname: Blix
authors.affiliation: Department of Radiology, University Hospital of North Norway, Tromsø, Norway.
authors.forename: Merethe H
authors.identifier: http://orcid.org/0000-0002-6567-4183
authors.initials: MH
authors.lastname: Kumle
authors.affiliation: Homebirth Association, Region Zealand, Sorø, Denmark.
authors.forename: Karen
authors.identifier: http://orcid.org/0000-0002-6705-5204
authors.initials: K
authors.lastname: Ingversen
authors.affiliation: Unit for Clinical Genetics, Oslo University Hospital, Oslo, Norway.
authors.forename: Anette S
authors.identifier: http://orcid.org/0000-0002-3960-8086
authors.initials: AS
authors.lastname: Huitfeldt
authors.affiliation: The Research Unit, Women's and Children's Health, The Juliane Marie Centre for Women, Children and Reproduction, Copenhagen University Hospital Rigshospitalet, Copenhagen, Denmark.
authors.forename: Hanne K
authors.identifier: http://orcid.org/0000-0002-7093-0719
authors.initials: HK
authors.lastname: Hegaard
authors.affiliation: Department of Midwifery, Faculty of Nursing, University of Iceland, Reykjavík, Iceland.
authors.forename: Ólöf Á
authors.identifier: http://orcid.org/0000-0003-3315-4543
authors.initials: ÓÁ
authors.lastname: Ólafsdóttir
authors.affiliation: Department of Obstetrics and Gynecology, University Hospital of North Norway, Tromsø, Norway.|Women's Health and Perinatology Research Group, Department of Clinical Medicine, Faculty of Health Sciences, University of Tromsø, Tromsø, Norway.
authors.forename: Pål
authors.initials: P
authors.lastname: Øian
authors.affiliation: Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Helena
authors.identifier: http://orcid.org/0000-0002-4875-1407
authors.initials: H
authors.lastname: Lindgren
mesh_terms: D000328:Adult; D005260:Female; D006700:Home Childbirth; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D007744:Obstetric Labor Complications / Q000628:therapy*; D010360:Patient Transfer; D011247:Pregnancy; D011256:Pregnancy Outcome; D011446:Prospective Studies; D012042:Registries; D012306:Risk; D012537:Scandinavian and Nordic Countries
keywords: Planned home birth; indications for transfers; midwifery; potentially urgent transfer; transfer to hospital