Planned Home Birth In Victoria From 2000 to 2013 Among ‘Higher Risk’ Women

Miranda Davies-Tuck, Mary-Ann Davey, Jeremy Oats, Euan Wallace Ritchie Centre, Hudson Institute of Medical Resarch, the Monash University, the University of Melbourne Background: Home birth is considered suitable for women who are ‘low risk’. In Victoria it is not known how many women who plan to birth at home would be considered ‘higherrisk’. The rates of adverse outcomes and obstetric intervention in these women are also unknown. Methods: A cohort study of routinely collected perinatal data for Victoria from 2000–2013. Preterm births or those with congenital anomalies were excluded. Women were identified as “higher risk” if they had a multiple pregnancy, were post-term (? 42 weeks), had a non-cephalic presentation, were obese (BMI Class 2), had a prior caesarean, were grand multiparous (? 5 births) or had a significant maternal medical condition. Rates of adverse perinatal and maternal outcomes, and obstetric interventions were compared between higher risk women planning to birth at home and those planning to birth in hospital. Results: 791 “higher risk” women planned to birth at home compared to 270, 494 who planned to birth in hospital. Women of “higher risk” who planned to birth at home experienced 5 times the rate of stillbirth, 7 times the rate of neonatal mortality and up to 19 times the rate of some perinatal morbidities (p < 0.001 for all) compared to those who planned to birth in hospital. Women who planned to birth at home also experienced higher rates of some but not all maternal morbidities but lower rates of obstetric intervention. Conclusion: This information may be useful to inform decisions around planned place of birth for “higher risk” women.