Obstetric practices in planned home births assisted in Brazil

This is a descriptive study, with data collected in an online bank maintained by 49 professionals from December 2014 to November 2015, in which the target population was women and newborns assisted in home births. Data were analyzed through descriptive statistics.

Results:

A total of 667 women and 665 newborns were included. Most of the women gave birth at home (84.4%), in a nonlithotomic position (99.1%); none underwent episiotomy; 32.3% had intact perineum; and 37.8% had first-degree lacerations, some underwent amniotomy (5.4%), oxytocin administration (0.4%), and Kristeller’s maneuver (0.2%); 80.8% of the women with a previous cesarean section had home birth. The rate of transfer of parturients was 15.6%, of puerperal women was 1.9%, and of neonates 1.6%. The rate of cesarean section in the parturients that started labor at home was 9.0%.

Conclusion:

The obstetric practices taken are consistent with the scientific evidence; however, unnecessary interventions are still performed. The rates of cesarean sections and maternal and neonatal transfers are low. Home can be a place of birth option for women seeking a physiological delivery.

DESCRIPTORS:
Home Childbirth; Humanizing Delivery; Obstetric Nursing; Observational Study

Variables	n	%
Age (mean, in years)	30.9 (SD = 4.5)
Level of education (n = 660)
Secondary school	8	1.2
High school	103	15.6
Graduate studies	433	65.6
Postgraduate studies	116	17.6
Region of residence
Southeast	271	40.7
South	169	25.3
Northeast	122	18.3
Center-west	105	15.7
Prenatal consultations
≤ 6	73	10.9
> 6	594	89.1
Previous births
None	372	55.8
≥ 1 vaginal delivery*	191	28.6
≥ 1 C-section	79	11.9
≥ 1 vaginal delivery† and C-section	25	3.7
Gestational age (mean, in weeks) (n = 653)	39^5/7 (SD = 1.2)
< 37‡	4	0.6
37 - 39	297	45.5
40 - 41	324	49.6
≥ 42	28	4.3

Obstetric practices	n	%
Amniotomy	36	5.4
Amniotic bag integrity until the expulsive period	117	17.5
Oxytocin at labor	1	0.1
Oxytocin at delivery (n = 563)	2	0.3
Vacuum extraction vaginal delivery* (n = 563)	3	0.5
Kristeller’s maneuver (n = 563)	1	0.2
Intact perineum (n = 555)	182	32.8
Parturient transfer	104	15.6
Puerperal women transfer (n = 563)	11	1.9
NB transfer (n = 561)	9	1.6

Birth position*	n	%
Out of water	292	52.6
Birthing stool	130	23.42
All fours/genupectoral	49	8.8
Supported squatting	33	6.0
Sitting/semi-sitting	24	4.3
Upright	20	3.6
Kneeling	17	3.1
Sims	14	2.5
Gynecological	3	0.5
McRoberts	1	0.2
In the hammock	1	0.2
In the water (pool)	233	42.0
Sitting/semi-sitting	119	21.4
All fours/genupectoral	52	9.4
Squatting	51	9.2
Sims	6	1.1
Kneeling	3	0.5
Upright	1	0.2
Birthing stool	1	0.2
In the shower in any position	30	5.4

Previous delivery	Current delivery at home	Current delivery in the hospital
	Current delivery at home	Vaginal	C-section
	n (%)	n (%)	n (%)
C-section (n = 79)	60 (75.9)	7 (8.9)	12 (15.2)
C-section and vaginal birth (n = 25)	24 (96.0)	-	1 (4.0)

Universidade de São Paulo, Escola de Enfermagem Av. Dr. Enéas de Carvalho Aguiar, 419 , 05403-000 São Paulo - SP/ Brasil, Tel./Fax: (55 11) 3061-7553, - São Paulo - SP - Brazil
E-mail: reeusp@usp.br

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[1] Corresponding author: Odaléa Maria Bruggemann Rua Deputado Antônio Edu Vieira, 1020, apto 204 B, Bairro Pantanal CEP 88040-001 - Florianópolis, SC, Brazil odalea.ufsc@gmail.com

Brasil

Brasil

Obstetric practices in planned home births assisted in Brazil* * Extracted from the thesis: “Parto domiciliar planejado assistido por profissional qualificado nas Regiões Nordeste, Centro-Oeste, Sudeste e Sul do Brasil”, Universidade Federal de Santa Catarina, 2016.

ABSTRACT

Objective:

Method:

Results:

Conclusion:

Obstetric practices in planned home births assisted in Brazil^* * Extracted from the thesis: “Parto domiciliar planejado assistido por profissional qualificado nas Regiões Nordeste, Centro-Oeste, Sudeste e Sul do Brasil”, Universidade Federal de Santa Catarina, 2016.