Is there a maximum transfer time for safe planned home births? Building evidence to

Abstract Evidence-based assessment of suitability for planned home birth (PHB) is a critical component of safe, effective home birth services. This study aimed to build an evidence base to inform transfer time recommendations for the Health Service Executive (HSE) Home Birth Service in Ireland. Transfer rates, time and distance were described for women who began labour at home with the HSE Home Birth Service between 2012 and 2021. Binary logistic regression was used to identify factors associated with intrapartum transfer and to examine the relationship between transfer time and outcomes. A survey on home birth policy and practice was issued to informants in countries offering comparable services to the HSE. Of 2,000 women initiating labour at home, 376 (18.9%) required intrapartum transfer, with transfer rates of 48.2% and 10.1% for primiparous and multiparous women, respectively. Primiparity (aOR: 8.95, 95% CI 6.89-11.7, p < 0.001) and maternal body mass index ≥30 (aOR: 1.93, 95% CI 1.14-3.20, p = 0.013) significantly increased the odds of intrapartum transfer. Serious adverse outcomes were rare in those requiring intrapartum transfer. No statistically significant increase in poor outcomes was detected with increasing transfer time; however, statistical power to detect small but important effects was limited. In other home birth services, transfer time is explicitly considered when assessing suitability; information provided to women includes details on transfer rates and times. While this study did not find a threshold time associated with increased risk of adverse outcomes for PHB, it has highlighted the significance of transfer time in shared decision-making on birthplace. Women considering PHB should receive parity-specific information on outcomes including transfer rates. This work highlights the pivotal role of Public Health in ensuring that evidence is combined with expert judgement and womens’ preferences to provide high quality, accessible, person-centred services. Key messages • Transfer time plays a key role in supporting shared decision-making for women considering a home birth. • This study identified opportunities to extend the comprehensiveness of assessment of suitability for planned home births using local and international evidence.