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How many of nulliparous women – and their babies - intending a home delivery have to be transferred to hospital during or after delivery?

There is a documented increased risk of maternal and neonatal complications associated with a woman’s first delivery. Stockholm County Council (SCC) only supports midwifery-led home deliveries for healthy multiparas with a history of complication-free pregnancies and deliveries. Since financial support for nulliparous women was recently sought, however, the SCC Advisory Committee of Reproduction was asked to supply a systematic review of the increased risks for this group of women.

In this systematic review, some 20 articles and five systematic reviews were assessed for quality. Many studies were excluded because results for nulliparous were not reported separately, the studies were of poor quality, or physicians were frequently involved.

The only study that met our criteria was a 2011 prospective nationwide English cohort study of high quality covering 4 500 planned midwifery-led home deliveries for nulliparous women and a full 10 000 nulliparous deliveries at obstetric units. The level of evidence was assessed using the GRADE system.


  • There is a low level of evidence supporting an increase in risk of serious complications for babies of nulliparous wonen with planned midwifery-led home deliveries as compared to deliveries at obstetric units, GRADE ⊕⊕. This finding is supported by the fact that 45 % of women/babies in planned home deliveries were transported to an obstetric unit during or shortly after delivery.
  • For maternal mortality, perineal trauma and need for blood transfusion, there is a low level of evidence for there being no differences depending on planned place of delivery, GRADE ⊕⊕.

This Health Technology Assessment has been conducted by Margareta Johansson, midwife, Helena Lindgren, midwife and Lennart Nordström, specialist in obstetrics and gynecology in cooperation with Elisabeth Persson, medical adviser and May Blom, nurse, and their team, at the HTA-center in Stockholm County Council-Region Gotland, Sweden.

Included and excluded articles

Search documentation

Search strategy

Report in Swedish