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Suárez-Baquero DFM, Joseph J, McLemore MR. Traditional Black Midwifery to Enhance Birth Justice. J Obstet Gynecol Neonatal Nurs 2024:S0884-2175(24)00257-0. [PMID: 39142636 DOI: 10.1016/j.jogn.2024.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 07/07/2024] [Accepted: 07/25/2024] [Indexed: 08/16/2024] Open
Abstract
In this commentary, we explore the significance of traditional Black midwifery practices across diaspora and global contexts, focusing on their potential for birth justice. By integrating cultural, health, and historical perspectives, we highlight the transformative power of traditional Black midwifery. Furthermore, we address the challenges that Black traditional and formally trained midwives face within contemporary health care systems. Barriers such as legal restrictions, limited recognition, and inadequate resources hinder the integration of Black midwifery into formal health care frameworks. Finally, strategies to promote collaboration, cultural, and respectful dialogue between traditional Black midwives and modern health care providers are proposed to overcome these challenges.
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Velo Higueras M, Douglas F, Kennedy C. Exploring women's motivations to freebirth and their experience of maternity care: A systematic qualitative evidence synthesis. Midwifery 2024; 134:104022. [PMID: 38718432 DOI: 10.1016/j.midw.2024.104022] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Revised: 04/25/2024] [Accepted: 04/29/2024] [Indexed: 06/17/2024]
Abstract
BACKGROUND Freebirth is currently defined as the deliberate decision to give birth without a regulated healthcare professional. Previous reviews have identified factors influencing women's decision to freebirth, yet there is limited evidence on what is the care experience for women who opt to freebirth. AIM To synthesise the qualitative evidence on women's motivations to freebirth and their experience of maternity care when deciding to freebirth. METHODS We conducted a qualitative evidence synthesis using a sensitive search strategy in May 2022 and August 2023. Twenty-two publications between 2008 and 2023 and from ten different high-income countries were included. Thematic synthesis, underpinned by a feminist standpoint, was used to analyse the data. FINDINGS Three main analytical themes were developed in response to each of the review questions. 'A quest for a safer birth' describes the factors influencing women's decision to freebirth. 'Powerful and powerless midwives' describes women's perceptions of their care providers (mostly midwives) and how these perceptions influenced their decision to freebirth. 'Rites of self-protection' describes women's care experiences and self-care practices in the pregnancy leading to freebirth DISCUSSION: Freebirth was rarely women's primary choice but the result of structural and relational barriers to access wanted care. Self-care in the form of freebirth helped women to achieve a positive birth experience and to protect their reproductive self-determination. CONCLUSION A new woman-centred definition of freebirth is proposed as the practice to self-care during birth in contexts where emergency maternity care is readily available.
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Affiliation(s)
- Maria Velo Higueras
- School of Nursing, Midwifery and Paramedic practice, Ishbel Gordon Building, Robert Gordon University, Garthdee Rd, Aberdeen AB10 7QE, United Kingdom.
| | - Flora Douglas
- School of Nursing, Midwifery and Paramedic practice, Ishbel Gordon Building, Robert Gordon University, Garthdee Rd, Aberdeen AB10 7QE, United Kingdom
| | - Catriona Kennedy
- School of Nursing, Midwifery and Paramedic practice, Ishbel Gordon Building, Robert Gordon University, Garthdee Rd, Aberdeen AB10 7QE, United Kingdom
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Hu Y, Allen J, Ellwood D, Slavin V, Gamble J, Toohill J, Callander E. The financial impact of offering publicly funded homebirths: A population-based microsimulation in Queensland, Australia. Women Birth 2024; 37:137-143. [PMID: 37524616 DOI: 10.1016/j.wombi.2023.07.129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 07/17/2023] [Accepted: 07/19/2023] [Indexed: 08/02/2023]
Abstract
BACKGROUND Despite strong evidence of benefits and increasing consumer demand for homebirth, Australia has failed to effectively upscale it. To promote the adoption and expansion of homebirth in the public health care system, policymakers require quantifiable results to evaluate its economic value. To date, there has been limited evaluation of the financial impact of birth settings for women at low risk of pregnancy complications. OBJECTIVE This study aimed to examine the difference in inpatient costs around birth between offering homebirth in the public maternity system versus not offering public homebirth to selected women who meet low-risk pregnancy criteria. METHODS We used a whole-of-population linked administrative dataset containing all women who gave birth in Queensland (one Australian State) between 01/07/2012 and 30/06/2018 where publicly funded homebirth is not currently offered. We created a static microsimulation model to compare the inpatient cost difference for mother and baby around birth based on the women who gave birth between 01/07/2017 and 30/06/2018 (n = 36,314). The model comprised of a base model - representing standard public hospital care, and a counterfactual model - representing a hypothetical scenario where 5 % of women who gave birth in public hospitals planned to give birth at home prior to the onset of labour (n = 1816). Costs were reported in 2021/22 AUD. RESULTS In our hypothetical scenario, after considering the effect of assumptive place and mode of birth for these planned homebirths, the estimated State-level inpatient cost saving around birth (summed for mother and babies) per pregnancy were: AU$303.13 (to Queensland public hospitals) and AU$186.94 (to Queensland public hospital funders). This calculates to a total cost saving per annum of AU$11 million (to Queensland public hospitals) and AU$6.8 million (to Queensland public hospital funders). CONCLUSION A considerable amount of inpatient health care costs around birth could be saved if 5 % of women booked at their local public hospitals, planned to give birth at home through a public-funded homebirth program. This finding supports the establishment and expansion of the homebirth option in the public health care system.
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Affiliation(s)
- Yanan Hu
- Monash Centre for Health Research and Implementation, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
| | - Jyai Allen
- Monash Centre for Health Research and Implementation, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia; Molly Wardaguga Research Centre, Charles Darwin University, Brisbane, Australia
| | - David Ellwood
- School of Medicine & Dentistry, Griffith University, Gold Coast, Australia; Gold Coast University Hospital, Gold Coast Hospital and Health Service, Southport, Australia
| | - Valerie Slavin
- Monash Centre for Health Research and Implementation, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia; Gold Coast University Hospital, Gold Coast Hospital and Health Service, Southport, Australia; School of Nursing and Midwifery, Griffith University, Gold Coast, Australia
| | - Jenny Gamble
- School of Nursing and Midwifery, Griffith University, Gold Coast, Australia; School of Nursing, Midwifery and Health, Coventry University, Coventry, United Kingdom
| | - Jocelyn Toohill
- School of Nursing, Midwifery and Health, Coventry University, Coventry, United Kingdom; Clinical Excellence Division, Queensland Health, Queensland, Australia
| | - Emily Callander
- Monash Centre for Health Research and Implementation, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia.
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Johansson M, Jansson O, Lilja F, Ekéus C, Volgsten H. Freebirth, the only option for women who do not fit into common practice- A Swedish national interview study. SEXUAL & REPRODUCTIVE HEALTHCARE 2023; 37:100866. [PMID: 37295181 DOI: 10.1016/j.srhc.2023.100866] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2023] [Revised: 05/20/2023] [Accepted: 05/29/2023] [Indexed: 06/12/2023]
Abstract
OBJECTIVE To explore women's experience of freebirth, as giving birth without the presence of a skilled healthcare professional such as a midwife. METHODS Online semi-structured interviews with nine multiparous women in Sweden. A qualitative experiential approach, as described by Burnard, was followed for data analysis. RESULTS The five main categories explored were: (i) previous negative experiences of hospital care as a reason for freebirth; (ii) receiving support for the decision of freebirth was crucial; (iii) longing for individual midwifery-assisted home-birthing support; (iv) to give birth in peace and in self-control, in the safe home environment; and (v) helpful support during labor and birth was appreciated. CONCLUSIONS The women in the study had a powerful and positive experience of freebirth, but individual midwifery birthing support was also requested. Easily available and respectful midwifery support should be offered to all childbearing women.
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Affiliation(s)
- Margareta Johansson
- Uppsala University, Department of Women's and Children's Health, Akademiska University Hospital, SE-751 85 Uppsala, Sweden.
| | - Olivia Jansson
- Akademiska University Hospital, Department of Obstetrics and Gynaecology, SE-751 85 Uppsala, Sweden.
| | - Fanny Lilja
- BB Stockholm Family Kungsholmen, Sankt Eriksgatan 44, SE-112 34 Stockholm, Sweden.
| | - Cecilia Ekéus
- Uppsala University, Department of Women's and Children's Health, SE-751 85 Uppsala, Sweden.
| | - Helena Volgsten
- Uppsala University, Department of Public Health and Caring Sciences, SE-75122 Uppsala University, Uppsala, Sweden.
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Gillen P, Bamidele O, Healy M. Systematic review of women's experiences of planning home birth in consultation with maternity care providers in middle to high-income countries. Midwifery 2023; 124:103733. [PMID: 37307778 DOI: 10.1016/j.midw.2023.103733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 05/04/2023] [Accepted: 05/18/2023] [Indexed: 06/14/2023]
Abstract
AIM To synthesise findings from published studies, which reported on women's experiences of planning a home birth in consultation with maternity care providers. DESIGN Systematic Review DATA SOURCES: We searched seven bibliographic databases, (Ovid Medline, Embase, PsycInfo, CINAHL plus, Scopus, ProQuest and Cochrane (Central and Library), from January 2015 to 29th April 2022. REVIEW METHODS Primary studies were included if they investigated women's experiences of planning a home birth with maternity care providers, in upper-middle and high-income countries and written in English language. Studies were analysed using thematic synthesis. GRADE-CERQual was used to assess the quality, coherence, adequacy and relevance of data. The protocol is registered on PROSPERO registration ID: CRD 42018095042 (updated 28th September 2020) and published. RESULTS 1274 articles were retrieved, and 410 duplicates removed. Following screening and quality appraisal, 20 eligible studies (19 qualitative and 1 survey) involving 2,145 women were included. KEY CONCLUSIONS Women's prior traumatic experience of hospital birth and a preference for physiological birth motivated their assertive decision to have a planned home birth despite criticisms and stigmatisation from their social circle and some maternity care providers. Midwives' competence and support enhanced women's confidence and positive experiences of planning a home birth. IMPLICATIONS FOR PRACTICE This review highlights the stigma that some women feel and the importance of support from health professionals, particularly midwives when planning a home birth. We recommend accessible evidence-based information for women and their families to support women's decision-making for planned home birth. The findings from this review can be used to inform woman-centred planned home birth services, particularly in the UK, (although evidence is drawn from papers in eight other countries, so findings are relevant elsewhere), which will impact positively on the experiences of women who are planning home birth.
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Affiliation(s)
- Patricia Gillen
- Southern Health and Social Care Trust, 10 Moyallen Road, Gilford, Co Down, Northern Ireland, UK; Institute of Nursing and Health Research, Ulster University, Shore Road, Newtownabbey, BT37 0QB, Northern Ireland, UK.
| | - Olufikayo Bamidele
- Institute of Nursing and Health Research, Ulster University, Shore Road, Newtownabbey, BT37 0QB, Northern Ireland, UK; School of Nursing and Midwifery, Queen's University Belfast BT9 7BL, Northern Ireland, UK; Institute for Clinical and Applied Health Research, Hull York Medical School, University of Hull, HU6 7RX, UK.
| | - Maria Healy
- School of Nursing and Midwifery, Queen's University Belfast BT9 7BL, Northern Ireland, UK.
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Ford P, Crowther S, Waller N. Midwives' experience of personal/professional risk when providing continuity of care to women who decline recommendations: A meta-synthesis of qualitative studies. Women Birth 2023; 36:e283-e294. [PMID: 35869010 DOI: 10.1016/j.wombi.2022.06.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Revised: 05/19/2022] [Accepted: 06/28/2022] [Indexed: 10/17/2022]
Abstract
PROBLEM Women's autonomous choices in pursuit of physiological childbirth are sometimes limited by the midwife's willingness to support those choices, particularly when those choices are contrary to recommendations or outside of guidelines. BACKGROUND Women's reasons for making such choices have received some research attention, however there is a paucity of research examining this phenomenon from the perspective of caseloading midwives' and their perception of personal/professional risk in such situations. AIM To synthesise qualitative research which includes the voices of midwives working in a continuity of carer model who perceive any kind of risk to themselves when caring for women who decline current established recommendations. METHODS Systematic literature search and meta-synthesis were carried out following a pre-determined search strategy. The search was executed in April 2021 and updated in July 2021. Studies were assessed for quality using JBI Critical Appraisal Checklist for Qualitative Research. Data extraction was assisted by JBI QARI Data Extraction Tool for Qualitative Research. GRADE-CERQual was applied to the findings. FINDINGS Eight studies qualified for inclusion. Five main themes were synthesised as third order constructs and were incorporated into a line of argument: Women's rights to bodily autonomy and choice in childbearing are violated, and their ability to access safe midwifery care in pursuit of physiological birth is restricted, when midwives practise within a maternity system which is adversarial towards midwives who provide the care which women require. Midwives who provide such care place themselves at risk of damaged reputation, collegial conflict, intimidating disciplinary processes, tensions of 'being torn', and a heavy psychological load. Despite these personal and professional risks, midwives who provide this care do so because it is the ethical and moral thing to do, because they recognise that women need them to, because it can be very rewarding, and because they are able to. CONCLUSION Maternity systems and colleagues can be key risk factors for caseloading midwives who facilitate women's right to decline recommendations. These identified risks can make it unsustainable for midwives to continue providing woman-centred care and contribute to workforce attrition, reducing options/choices for women which paradoxically increases risk to women and babies.
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Affiliation(s)
| | - Susan Crowther
- AUT University, Faculty of Health and Environmental Sciences, Centre for Midwifery and Women's Health Research, New Zealand.
| | - Nimisha Waller
- Postgraduate Programme Leader (Midwifery), AUT University, Faculty of Health and Environmental Sciences, Centre for Midwifery and Women's Health Research, New Zealand.
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Women and maternity care providers experiences of planned home birth in Northern Ireland: A descriptive survey. Women Birth 2023:S1871-5192(23)00018-5. [PMID: 36740477 DOI: 10.1016/j.wombi.2023.01.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/02/2022] [Revised: 12/30/2022] [Accepted: 01/23/2023] [Indexed: 02/05/2023]
Abstract
BACKGROUND Where a woman gives birth impacts both her postnatal outcomes and experiences. However, for women who plan home birth in Northern Ireland, their experiences and that of their maternity care providers are rarely sought. AIM This study examined women's and maternity care providers' experiences and perceptions of home birth service provision in Northern Ireland. METHODS Online surveys were used to investigate the experiences of women (n = 62) who had experienced a home birth or had a view on planned home birth and maternity care providers (n = 77) who offered home birth services in Northern Ireland between November 2018 and November 2020. The surveys were analysed using descriptive statistics. FINDINGS The women were all multigravida, with 39 experiencing a planned home birth and three having an intrapartum transfer. Most of the women (61.3 %; n = 38/62) knew about home birth services through social media or friends and 91% (n = 57/62) discussed their plans for home birth with their maternity care providers antenatally. Maternity care providers were mostly supportive (64.9 %; n = 50/77) of women having a choice about place of birth. Midwives were mostly confident (52 %; n = 13/25) or very confident (28 %; n = 7) about caring for women having a planned home birth but did not always feel supported by colleagues. DISCUSSION Most women rated their care as excellent or very good. Midwives reported limited support from colleagues for home birth provision. CONCLUSION There is a need to support women in their birthplace choice and empower maternity care providers to facilitate this through a fully resourced home birth service infrastructure and collegial support.
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Coddington R, Fox D, Scarf V, Catling C. Getting kicked off the program: Women's experiences of antenatal exclusion from publicly-funded homebirth in Australia. Women Birth 2023; 36:e179-e185. [PMID: 35764492 DOI: 10.1016/j.wombi.2022.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 06/09/2022] [Accepted: 06/20/2022] [Indexed: 01/25/2023]
Abstract
PROBLEM Eligibility criteria for publicly-funded homebirth models are strict and, as such, many women who initially plan a homebirth later become excluded. BACKGROUND Fifteen publicly-funded homebirth programs are operating in Australia, offering eligible women the opportunity to give birth at home at no cost, with the care of a hospital-employed midwife. AIM To explore the experiences of women who planned a publicly-funded homebirth and were later excluded due to pregnancy complications or risk factors. METHODS A qualitative descriptive approach was taken. Recruitment was via social media sites specifically related to homebirth in Australia. Data collection involved semi-structured telephone interviews. Transcripts were thematically analysed. FINDINGS Thirteen women participated. They were anxious about 'Jumping through hoops' to maintain their low-risk status. After being 'Kicked off the program', women carefully 'negotiated the system' in order to get the birth they wanted in hospital. Some women felt bullied and coerced into complying with hospital protocols that did not account for their individual needs. Maintaining the midwife-woman relationship was a protective factor, decreasing negative experiences. DISCUSSION Women plan a homebirth to avoid the medicalised hospital environment and to gain access to continuity of midwifery care. To provide maternity care that is acceptable to women, hospital institutions need to design services that enable continuity of the midwife-woman relationship and assess risk on an individual basis. CONCLUSION Exclusion from publicly-funded homebirth has the potential to negatively impact women who may feel a sense of loss, uncertainty or emotional distress related to their planned place of birth.
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Affiliation(s)
- Rebecca Coddington
- Centre for Midwifery, Child and Family Health, University of Technology Sydney, Australia.
| | - Deborah Fox
- Centre for Midwifery, Child and Family Health, University of Technology Sydney, Australia. https://twitter.com/@debjfox
| | - Vanessa Scarf
- Centre for Midwifery, Child and Family Health, University of Technology Sydney, Australia. https://twitter.com/@VScarf
| | - Christine Catling
- Centre for Midwifery, Child and Family Health, University of Technology Sydney, Australia. https://twitter.com/@ChristineCatli1
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Lou S, Dahlen HG, Gefke Hansen S, Ørneborg Rodkjær L, Maimburg RD. Why freebirth in a maternity system with free midwifery care? A qualitative study of Danish women's motivations and preparations for freebirth. SEXUAL & REPRODUCTIVE HEALTHCARE 2022; 34:100789. [PMID: 36332498 DOI: 10.1016/j.srhc.2022.100789] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 09/12/2022] [Accepted: 10/24/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Even in maternity care systems with free midwifery care, some women intentionally choose to birth unattended by any health professional (freebirth). Women who choose freebirth represent an enigma for many, and a provocation to some. However, people who do not conform to dominant medical practices are a source of valuable insights that can reveal shortcomings in the mainstream health care system. Thus, the aim of this study was to explore and understand women's motivations and preparations for freebirth. METHODS The study was informed by the theoretical lens of the 'undisciplined patient'. Qualitative, in-depth interviews were performed with ten Danish women, who for their most recent birth had planned to freebirth. Data were analysed using reflexive thematic analysis. RESULTS Four themes were identified. "The standard system is not for me" describes negative experiences during previous births and the desire for more individualised support. "Re-establishing trust in myself" describes the women's quest for recognizing their own needs and re-building autonomy and inner strength. "I do my research" describes how the women sought new ways of knowing and prioritised experiential knowledge. And finally, "I create my safe space" describes the women's efforts to create the best possible physical and emotional space for themselves and their babies in order to have a safe and autonomous birth experience. CONCLUSION Freebirth is not undertaken lightly or without preparation by women. Improved continuity of care as well as greater flexibility in hospital guidelines could accommodate some of these women's demand for autonomy in birth.
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Affiliation(s)
- Stina Lou
- Defactum - Public health & Health Services Research, Central Denmark Region, Aarhus, Denmark; Center for Fetal Diagnostics, Aarhus University Hospital, Aarhus, Denmark; Department of Clinical Medicine, Health, Aarhus University, Aarhus, Denmark.
| | - Hannah G Dahlen
- School of Nursing and Midwifery, Western Sydney University, Penrith, NSW, Australia
| | - Sofie Gefke Hansen
- Defactum - Public health & Health Services Research, Central Denmark Region, Aarhus, Denmark
| | - Lotte Ørneborg Rodkjær
- Research Centre for Patient Involvement (ResCenPI), Infectious Diseases, Aarhus University Hospital, Aarhus, Denmark; Department of Public Health, Health, Aarhus University, Aarhus, Denmark
| | - Rikke Damkjær Maimburg
- Department of Clinical Medicine, Health, Aarhus University, Aarhus, Denmark; School of Nursing and Midwifery, Western Sydney University, Penrith, NSW, Australia; Department of Obstetrics & Gynecology, Aarhus University Hospital, Aarhus, Denmark; Department of Midwifery, University College of Northern Denmark, Aalborg, Denmark
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Wami GA, Prémusz V, Csákány GM, Kálmán K, Vértes V, Tamás P. Characteristics of Homebirth in Hungary: A Retrospective Cohort Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:10461. [PMID: 36012096 PMCID: PMC9407858 DOI: 10.3390/ijerph191610461] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/04/2022] [Revised: 08/15/2022] [Accepted: 08/19/2022] [Indexed: 06/15/2023]
Abstract
Homebirth is legal and has been regulated by law in Hungary since 2012. Despite the obvious advantages of homebirth, it has not yet been broadly accepted, due to various opinions related to safety and risks associated with giving birth outside of a hospital. Our study aimed at exploring both real maternal and feto-neonatal characteristics associated with Hungarian homebirths. A total of 2997 cases were considered in support of our retrospective cohort study. In the examined period, there was a significant, continual rise in the number of homebirths by a rate of 0.22% on average per year. Aggregated maternal complications (primary uterine inertia, prolonged second stage labour, and third stage haemorrhage) were prevalent among homebirth cases (1.29% vs. 0.72%, p < 0.05) and were associated with an average of 11.77% rate of transfer to a health care institution. On the other hand, the rate of operative (vaginal or caesarean) delivery was 26.31% among institutionalized births. A slightly better Apgar score and relatively high rate (20%) of caesarean deliveries were correlated with institutionalized births (p < 0.05). However, the overall intervention rate was lower among homebirths (0.11% vs. 42.57%) than institutional birth cases (p < 0.001). Overall, homebirth is a reliable option for childbirth for healthy and low-risk mothers with uncomplicated pregnancies, which is reflected in the increasing number of deliveries at home in Hungary. Furthermore, utilizing the experiences of countries where homebirth is a long-established method may further improve the outcome of homebirths in Hungary.
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Affiliation(s)
- Girma A. Wami
- Doctoral School of Health Sciences, Faculty of Health Sciences, University of Pécs, Vörösmarty u. 4, H-7621 Pécs, Hungary
| | - Viktória Prémusz
- Doctoral School of Health Sciences, Faculty of Health Sciences, University of Pécs, Vörösmarty u. 4, H-7621 Pécs, Hungary
- ELKH-PTE Human Reproduction Scientific Research Group, University of Pécs, Édesanyák u. 17, H-7624 Pécs, Hungary
| | - György M. Csákány
- Department of Obstetrics and Gynaecology, Jahn Ferenc Hospital, Kövesút 1, H-1204 Budapest, Hungary
| | - Kovács Kálmán
- ELKH-PTE Human Reproduction Scientific Research Group, University of Pécs, Édesanyák u. 17, H-7624 Pécs, Hungary
- Department of Obstetrics and Gynaecology, Faculty of Medicine, University of Pécs, Édesanyák u. 17, H-7624 Pécs, Hungary
| | - Viola Vértes
- ELKH-PTE Human Reproduction Scientific Research Group, University of Pécs, Édesanyák u. 17, H-7624 Pécs, Hungary
- Department of Obstetrics and Gynaecology, Faculty of Medicine, University of Pécs, Édesanyák u. 17, H-7624 Pécs, Hungary
| | - Péter Tamás
- Doctoral School of Health Sciences, Faculty of Health Sciences, University of Pécs, Vörösmarty u. 4, H-7621 Pécs, Hungary
- ELKH-PTE Human Reproduction Scientific Research Group, University of Pécs, Édesanyák u. 17, H-7624 Pécs, Hungary
- Department of Obstetrics and Gynaecology, Faculty of Medicine, University of Pécs, Édesanyák u. 17, H-7624 Pécs, Hungary
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Sweet L, Muller A, Kearney L, Martis R, Hartney N, Davey K, Daellenbach R, Hall H, Atchan M. Predictors and impact of women's breastfeeding self-efficacy and postnatal care in the context of a pandemic in Australia and Aotearoa New Zealand. Midwifery 2022; 114:103462. [PMID: 36001943 DOI: 10.1016/j.midw.2022.103462] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Revised: 07/05/2022] [Accepted: 08/16/2022] [Indexed: 11/26/2022]
Abstract
OBJECTIVE To investigate predictors of breastfeeding self-efficacy, postnatal care experiences, and there subsequent impact on breastfeeding outcomes in Australia and Aotearoa New Zealand in the context of the COVID-19 pandemic. DESIGN A cross-sectional online survey collected data between August and October 2020 with recruitment via social media. Quantitative data were analyzed using descriptive analyses, and linear and logistic regression analysis related to the Breastfeeding Self-Efficacy Scale-Short Form findings. Open text responses were analyzed using content analysis. FINDINGS There were 1001 complete responses. Visitor restrictions impacted the woman's early parenting experience in both positive and negative ways. One third of participants stated their postnatal needs were not met with 82 stating that they had no postnatal care at all. During the first six weeks postnatal, 48.1% felt not very or not at all confident caring for their baby. Despite 94.3% of participants initiating breastfeeding, only 70% were exclusively breastfeeding at six weeks. The mean self-efficacy score was 49.98 suggesting the need for additional help, with first time mothers having a statistically significant lower score. DISCUSSION/CONCLUSION Sub-optimal postnatal care and support negatively influence breastfeeding self-efficacy. Women desired additional help during the COVID-19 pandemic inclusive of support and education to meet their postnatal needs and exclusively breastfeed. IMPLICATIONS FOR PRACTICE Women require appropriate and timely postnatal care and support to promote confidence in caring for baby and achieve their breastfeeding goals. Preferably this care should be provided face-to-face.
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Affiliation(s)
- Linda Sweet
- School of Nursing and Midwifery, Deakin University, 221 Burwood Highway, Burwood 3125, Australia; Centre for Quality and Patient Safety Research, Western Health Partnership, Victoria, Australia.
| | - Amanda Muller
- College of Nursing and Health Sciences, Flinders University, South Australia, Australia
| | - Lauren Kearney
- School of Nursing, Midwifery and Social Work, University of Queensland, Australia
| | - Ruth Martis
- Liggins Institute, The University of Auckland, Aotearoa New Zealand
| | - Nicki Hartney
- School of Nursing and Midwifery, Deakin University, 221 Burwood Highway, Burwood 3125, Australia
| | - Kym Davey
- School of Nursing and Midwifery, Monash University, Australia
| | - Rea Daellenbach
- Department of Health Practice, Ara Institute of Canterbury, New Zealand
| | - Helen Hall
- School of Health, Federation University, Australia
| | - Marjorie Atchan
- School of Nursing, Midwifery & Public Health, University of Canberra, Australia
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Critiquing the evolution of maternity care preferences research: A systematic mixed studies review. Midwifery 2022; 111:103386. [DOI: 10.1016/j.midw.2022.103386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2021] [Revised: 05/09/2022] [Accepted: 05/23/2022] [Indexed: 11/22/2022]
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Blums T, Donnellan-Fernandez R, Sweet L. Women's perceptions of inclusion and exclusion criteria for publicly-funded homebirth - A survey. Women Birth 2021; 35:413-422. [PMID: 34518118 DOI: 10.1016/j.wombi.2021.08.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Revised: 08/13/2021] [Accepted: 08/19/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND There are 15 publicly-funded homebirth programs in Australia. Women's access to these programs is determined by program specific inclusion and exclusion criteria. AIMS To examine women's perception of inclusion and exclusion criteria for publicly-funded homebirth programs in Australia and how these perceptions may influence women's choices and access to these programs. METHODS A national online survey was conducted and promoted through social media networks to women interested in homebirth in Australia. Quantitative data were analysed to generate descriptive statistics and a content analysis was performed on qualitative data. FINDINGS A total of 830 surveys were collected. Most women were supportive of inclusion and exclusion criteria related to social and environmental factors, although there was ambivalence about requiring ambulance cover, not having a history of domestic violence in the current relationship and requiring the woman to speak basic English. With regards to obstetric factors, only a requirement for labour to commence spontaneously at term was supported by over half of participants. All other obstetric related criteria had over half of participants disagreeing or strongly disagreeing that they should be used to prevent a woman from birthing at home. A desire for choice and access was frequently mentioned in the qualitative data. CONCLUSION There is a need to address the lack of choice many women experience when pregnant and the lack of equitable access to affordable homebirth services in Australia.
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Affiliation(s)
- Tija Blums
- School of Nursing and Midwifery, Griffith University, Australia; Western Health, St Albans, VIC, Australia.
| | - Roslyn Donnellan-Fernandez
- School of Nursing and Midwifery, Griffith University, Australia; Transforming Maternity Care Collaborative, Australia. https://twitter.com/@RozDFernandez
| | - Linda Sweet
- Western Health, St Albans, VIC, Australia; School of Nursing & Midwifery, Faculty of Health, Deakin University, Australia. https://twitter.com/@ProfLindaSweet
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Dahlen HG, Thornton C, Downe S, de Jonge A, Seijmonsbergen-Schermers A, Tracy S, Tracy M, Bisits A, Peters L. Intrapartum interventions and outcomes for women and children following induction of labour at term in uncomplicated pregnancies: a 16-year population-based linked data study. BMJ Open 2021; 11:e047040. [PMID: 34059509 PMCID: PMC8169493 DOI: 10.1136/bmjopen-2020-047040] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
OBJECTIVES We compared intrapartum interventions and outcomes for mothers, neonates and children up to 16 years, for induction of labour (IOL) versus spontaneous labour onset in uncomplicated term pregnancies with live births. DESIGN We used population linked data from New South Wales, Australia (2001-2016) for healthy women giving birth at 37+0 to 41+6 weeks. Descriptive statistics and logistic regression were performed for intrapartum interventions, postnatal maternal and neonatal outcomes, and long-term child outcomes adjusted for maternal age, country of birth, socioeconomic status, parity and gestational age. RESULTS Of 474 652 included births, 69 397 (15%) had an IOL for non-medical reasons. Primiparous women with IOL versus spontaneous onset differed significantly for: spontaneous vaginal birth (42.7% vs 62.3%), instrumental birth (28.0% vs 23.9%%), intrapartum caesarean section (29.3% vs 13.8%), epidural (71.0% vs 41.3%), episiotomy (41.2% vs 30.5%) and postpartum haemorrhage (2.4% vs 1.5%). There was a similar trend in outcomes for multiparous women, except for caesarean section which was lower (5.3% vs 6.2%). For both groups, third and fourth degree perineal tears were lower overall in the IOL group: primiparous women (4.2% vs 4.9%), multiparous women (0.7% vs 1.2%), though overall vaginal repair was higher (89.3% vs 84.3%). Following induction, incidences of neonatal birth trauma, resuscitation and respiratory disorders were higher, as were admissions to hospital for infections (ear, nose, throat, respiratory and sepsis) up to 16 years. There was no difference in hospitalisation for asthma or eczema, or for neonatal death (0.06% vs 0.08%), or in total deaths up to 16 years. CONCLUSION IOL for non-medical reasons was associated with higher birth interventions, particularly in primiparous women, and more adverse maternal, neonatal and child outcomes for most variables assessed. The size of effect varied by parity and gestational age, making these important considerations when informing women about the risks and benefits of IOL.
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Affiliation(s)
- Hannah G Dahlen
- School of Nursing and Midwifery, Western Sydney University, Penrith South, New South Wales, Australia
| | - Charlene Thornton
- School of Nursing and Midwifery, Western Sydney University, Penrith South, New South Wales, Australia
- College of Nursing and Health Sciences, Flinders University Faculty of Medicine Nursing and Health Sciences, Adelaide, South Australia, Australia
| | - Soo Downe
- School of Nursing and Midwifery, Western Sydney University, Penrith South, New South Wales, Australia
- Research in Childbirth and Health (ReaCH) Unit, University of Central Lancashire, Preston, Lancashire, UK
| | - Ank de Jonge
- School of Nursing and Midwifery, Western Sydney University, Penrith South, New South Wales, Australia
- Midwifery Science, AVAG, Amsterdam Public Health, Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Anna Seijmonsbergen-Schermers
- Midwifery Science, AVAG, Amsterdam Public Health, Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
| | - Sally Tracy
- School of Medicine and Health, University of Sydney, Sydney, New South Wales, Australia
| | - Mark Tracy
- Westmead Newborn Intensive Care Unit, The University of Sydney Paediatrics and ChildHealth and WSLHD, Westmead, New South Wales, Australia
| | - Andrew Bisits
- School of Women's and Children's Health, University of New South Wales, Sydney, New South Wales, Australia
| | - Lilian Peters
- School of Nursing and Midwifery, Western Sydney University, Penrith South, New South Wales, Australia
- Midwifery Science, AVAG, Amsterdam Public Health, Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Department of General Practice and Elderly Care Medicine, University of Groningen, University Medical Center Groningen, Groningen, The Netherlands
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Blums T, Donnellan-Fernandez R, Sweet L. Inclusion and exclusion criteria for publicly-funded homebirth in Australia: A scoping review. Women Birth 2021; 35:23-30. [PMID: 33541812 DOI: 10.1016/j.wombi.2021.01.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Revised: 12/02/2020] [Accepted: 01/10/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND There are fifteen publicly-funded homebirth programs currently operating in Australia. Suitability for these programs is determined by a series of inclusion and exclusion criteria. AIM The aim of this scoping review is to identify common inclusion and exclusion criteria for publicly-funded homebirth programs and other related factors that affect access to these programs. METHODS A Google search was conducted for publicly-funded homebirth programs listed on the National Publicly-funded Homebirth Consortium website. Public websites, documents, and policies were analysed to identify inclusion and exclusion criteria for these programs. FINDINGS Eleven of the 15 publicly-funded homebirth programs mention the availability of homebirth on their health service website, with varying levels of information about the inclusion and exclusion criteria available. Two of the programs with no information on their health service website are covered by a state-wide guideline. Additional details were sought directly from programs and obtaining further information from some individual homebirth programs was challenging. Variation in inclusion and exclusion criteria exists between programs. Common areas of variation include restrictions relating to Body Mass Index, parity, age, English language ability, tests required during pregnancy, and gestation at booking to the homebirth program. CONCLUSION The inclusion and exclusion criteria for a publicly-funded homebirth program determines women's access to the program. Limited publicly available information regarding inclusion and exclusion criteria for many publicly-funded homebirth programs is likely to limit women's awareness of and access to these programs.
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Affiliation(s)
- Tija Blums
- Western Health, St Albans, VIC, Australia; School of Nursing and Midwifery, Griffith University, Australia.
| | - Roslyn Donnellan-Fernandez
- School of Nursing and Midwifery, Griffith University, Australia; Transforming Maternity Care Collaborative, Australia. https://twitter.com/@RozDFernandez
| | - Linda Sweet
- Western Health, St Albans, VIC, Australia; School of Nursing & Midwifery, Faculty of Health, Deakin University, Australia. https://twitter.com/@ProfLindaSweet
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Sharlov R, Taniar D, Phan T, Beare R, Srikanth V, Ma H, Farrell T, White C, Wallace EM, Davies-Tuck M. Where do low risk women live relative to maternity services across Victoria? Expanding access to public homebirth models across Victoria. Women Birth 2021; 35:e91-e97. [PMID: 33451928 DOI: 10.1016/j.wombi.2021.01.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Revised: 12/01/2020] [Accepted: 01/04/2021] [Indexed: 02/07/2023]
Abstract
PROBLEM Currently <1% of Australian women give birth at home. BACKGROUND In Australia there are very few options for women to access public funded homebirth. AIM We aimed to use geo-mapping to identify the number of women eligible for homebirth in Victoria, based on the criteria of uncomplicated pregnancies and residing within 15-25kms of suitable maternity services, to plan future maternity care options. METHODS Retrospective study of births between 2015 and 2017 in Victoria, Australia. All women who were identified as having a low risk pregnancy at the beginning of pregnancy were included. The number of women within 15 and 25km of a suitable Victorian public maternity hospital and catchment boundaries around each hospital were determined. FINDINGS Between 2015 and 2017, 126,830 low risk women gave birth in Victoria, of whom half live within 25km of seven Victorian hospitals. Currently, 2% of suitable women who live close to the current public homebirth models accessed them. DISCUSSION We present a method to inform the expansion of maternity service options using Victoria as an example. On the basis of the maximum number of low risk women living close by, we have also identified the Victorian maternity services that would be most suitable for creation of public homebirth or low risk continuity of midwifery models. CONCLUSION This approach could can be used to plan other maternity care services.
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Affiliation(s)
- Rodion Sharlov
- Faculty of Information Technology, Monash University, Australia
| | - David Taniar
- Faculty of Information Technology, Monash University, Australia
| | - Thanh Phan
- Department of Neurology, Monash Health, Australia; Faculty of Medicine, Monash University, Australia
| | - Richard Beare
- Faculty of Medicine, Monash University, Australia; Developmental Imaging, Murdoch Children's Research Institute, Melbourne, Australia
| | - Velandai Srikanth
- Academic Unit, Peninsula Health, Frankston, Melbourne, Australia; Peninsula Clinical School, Central Clinical School, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
| | - Henry Ma
- Department of Neurology, Monash Health, Australia
| | | | | | - Euan M Wallace
- Safer Care Victoria, Melbourne, Australia; Department of Obstetrics and Gynaecology, Monash University, Clayton, Victoria 3168, Australia
| | - Miranda Davies-Tuck
- Safer Care Victoria, Melbourne, Australia; Department of Obstetrics and Gynaecology, Monash University, Clayton, Victoria 3168, Australia; The Ritchie Centre, Hudson Institute of Medical Research, Clayton, Victoria 3168, Australia.
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