Home births versus transfers in women attended by nurse midwives in Rio de Janeiro –Brazil

Background: Nurse Midwives in Rio de Janeiro, Brazil, care for women who decide for home births. It is an autonomous work, in a highly medicalized urban center where home births are not recommended by doctors. In opposition to... [ view full abstract ]

Background: Nurse Midwives in Rio de Janeiro, Brazil, care for women who decide for home births. It is an autonomous work, in a highly medicalized urban center where home births are not recommended by doctors. In opposition to this model, these nurse midwives are required by women who wish to be cared for with a less interventionist practice, respecting the physiology of birth process. Objective: to analyze the determinant conditions for the transfer of women from a planned home birth to the hospital. Methods: this is a quantitative, descriptive study analyzing records of 70 planned a home birth attended by nurse midwives in Rio de Janeiro, Brazil, from 2013-2016. Results: among 70 planned home births, 80% of women had their babies at home and 20% needed to be transferred during the process; 51.4% were primiparous; the transfers occurred in the first or second stage of labor (85.7% -n=14) and in the postpartum period (14.2% - n=14). The main obstetric complications diagnosed in these 12 women transferred during labor were: labor progress stop 10(83,3%), due to cervical dilatation or fetal progress; and prolonged latent phase 2(16,6%). Of the women transferred in the postpartum period, one had moderate bleeding and hypotonic uterus within the first 24 hours after delivery, due to placental remnants, and the other one with adherent placenta. It is important to notice that in 100% of the transferred mothers, the babies had an Apgar score over than 8; 50% of women ended up to normal birth and 50% to caesarean section. The total caesarean section rate was 8.7%. Conclusion: The nurse midwives’ care for women who decided for a planned home birth in an urban center, despite the predominance of the medicalized model, respects the recommendations for a safe labor and childbirth. Intercurrences had timely and adequate diagnosis. The rates of caesarean sections have remained below the rates recommended by the World Health Organization.