Home Birth Midwifery in the United States

Complications of planned home births in the Czech Republic between 2016‒2017

OBJECTIVE

This study aimed to analyze the complications of planned home births treated at healthcare facilities in the Czech Republic.

METHODS

This prospective cohort observational study is based on analysis of women hospitalized with complications related to planned home deliveries in the Czech Republic between 2016 and 2017. The data were collected using an online form made accessible to the directors of all maternity hospitals in the Czech Republic. The results were statistically evaluated.

RESULTS

We identified 45 complications during planned home deliveries. Complications occurred most often among women living in largely populated cities with higher levels of education. Overall, 40% of patients did not receive routine antenatal care, and 38% of women gave birth after the 41st week of pregnancy. In 60% of cases, no professionals attended the birth. Hospital transfer frequencies were 42% after delivery, 36% at third-stage labour, 11% first-stage labour, 9% second-stage labour, and 2% before delivery. We recorded four neonatal deaths and one severe newborn morbidity. There was one maternal death unrelated to the home-birthing process and six cases of severe maternal haemorrhagic shock requiring intensive care.

CONCLUSION

Complications of planned home births occurred more frequently in women living in largely populated cities and with higher education levels. Planned home births were also observed among women who were at a higher risk of complications. Risk factors included nulliparity, postdate pregnancy, and lack of prenatal care. Hospital transfers occurred most often in the third stage of labour and postpartum.

Birth and the Big Bad Wolf: Biocultural Evolution and Human Childbirth, Part 2

In Part 2 of this two-part article, we further employ the lens of evolutionary medicine to explore similarities in premodern biocultural features of birth, arguing that these were an outgrowth of our common evolutionary heritage as bipedal primates. These practices grew out of the empiricism of millennia of trial and error and supported humans to give birth in closer alignment with our evolved biology. We argue that many common obstetric procedures today work against this evolved biology. In seeking to manage birth, we sometimes generate an obstetric paradox wherein we (over)intervene in human childbirth to try to keep it safe, yet thereby cause harm. We describe premodern birthing patterns in three sections: (a) eating and drinking at will and unrestrained movement in labor with upright pushing; (b) obligate midwifery and continuous labor support; and (c) the low-intervention birth/long-term breastfeeding/co-sleeping adaptive complex, and discuss how these are still relevant today. We conclude with a set of suggestions for improving the global technocratic treatment of birth and with a futuristic epilogue about a 7th, cyborgian pig that asks: What will become of birth as humans continue to coevolve with our technologies?

Planned home births: The role of the primary care NP

Over the past 15 years, there has been a steady resurgence of planned home births in the US. Multiple factors may impact health outcomes for mother and baby. NPs have the opportunity to provide reliable information to women to help ensure a safe delivery and to optimize care for the neonate.

Home and Birth Center Birth in the United States: Time for Greater Collaboration Across Models of Care

There has been a small, but significant, increase in community births (home and birth-center births) in the United States in recent years. The rate increased by 20% from 2004 to 2008, and another 59% from 2008 to 2012, though the overall rate is still low at less than 2%. Although the United States is not the only country with a large majority of births occurring in the hospital, there are other high-resource countries where home and birth-center birth are far more common and where community midwives (those attending births at home and in birth centers) are far more central to the provision of care. In many such countries, the differences in perinatal outcomes between hospital and community births are small, and there are lower rates of maternal morbidity in the community setting. In the United States, perinatal mortality appears to be higher for community births, though there has yet to be a national study comparing outcomes across settings that controls for planned place of birth. Rates of intervention, including cesarean delivery, are significantly higher in hospital births in the United States. Compared with the United States, countries that have higher rates of community births have better integrated systems with clearer national guidelines governing risk criteria and planned birth location, as well as transfer to higher levels of care. Differences in outcomes, systems, approaches, and client motivations are important to understand, because they are critical to the processes of person-centered care and to risk reduction across all birth settings.

Modernizing Evolutionary Anthropology : Introduction to the Special Issue

Evolutionary anthropology has traditionally focused on the study of small-scale, largely self-sufficient societies. The increasing rarity of these societies underscores the importance of such research yet also suggests the need to understand the processes by which such societies are being lost-what we call "modernization"-and the effects of these processes on human behavior and biology. In this article, we discuss recent efforts by evolutionary anthropologists to incorporate modernization into their research and the challenges and rewards that follow. Advantages include that these studies allow for explicit testing of hypotheses that explore how behavior and biology change in conjunction with changes in social, economic, and ecological factors. In addition, modernization often provides a source of "natural experiments" since it may proceed in a piecemeal fashion through a population. Challenges arise, however, in association with reduced variability in fitness proxies such as fertility, and with the increasing use of relatively novel methodologies in evolutionary anthropology, such as the analysis of secondary data. Confronting these challenges will require careful consideration but will lead to an improved understanding of humanity. We conclude that the study of modernization offers the prospect of developing a richer evolutionary anthropology, by encompassing ultimate and proximate explanations for behavior expressed across the full range of human societies.