1
|
Underwood K, Reddy UM, Hosier H, Sweeney L, Campbell KH, Xu X. Mode of Delivery in Antepartum Singleton Stillbirths and Associated Risk Factors. Am J Perinatol 2024; 41:e193-e203. [PMID: 35850142 DOI: 10.1055/s-0042-1750795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
Abstract
OBJECTIVE This study was aimed to investigate delivery management of patients with antepartum stillbirth. STUDY DESIGN Using data from fetal death certificates and linked maternal hospital discharge records, we identified a population-based sample of patients with singleton antepartum stillbirth at 20 to 42 weeks of gestation in California in 2007 to 2011. Primary outcomes were intended mode of delivery and actual mode of delivery. We used multivariable regressions to examine the association between patient demographic, clinical, and hospital characteristics and their mode of delivery. Separate analysis was performed for patients who had prior cesarean delivery versus those who did not. RESULTS Of 7,813 patients with singleton antepartum stillbirth, 1,356 had prior cesarean, while 6,457 had no prior cesarean. Labor was attempted in 51.8% of patients with prior cesarean and 93.7% of patients without prior cesarean, with 76.2 and 95.8% of these patients, respectively, delivered vaginally. Overall, 18.9% of patients underwent a cesarean delivery (60.5% among those with prior cesarean and 10.2% among those without prior cesarean). Multivariable regression analysis identified several factors associated with the risk of cesarean delivery that were not medically indicated. For instance, among patients without prior cesarean, malpresentation (of which the vast majority was breech presentation) was associated with an increased likelihood of planned cesarean (adjusted odds ratio [OR] = 3.26, 95% confidence interval [CI]: 2.53-4.22) and cesarean delivery after attempting labor (adjusted OR = 3.09, 95% CI: 2.25-4.25). For both patients with and without prior cesarean, delivery at an urban teaching hospital was associated with a lower likelihood of planned cesarean and a lower likelihood of cesarean delivery after attempting labor (adjusted ORs ranged from 0.28 to 0.56, p < 0.001 for all). CONCLUSION Over one in six patients with antepartum stillbirth underwent cesarean delivery. Among patients who attempted labor, rate of vaginal delivery was generally high, suggesting a potential opportunity to increase vaginal delivery in this population. KEY POINTS · In singleton antepartum stillbirths, 18.9% underwent cesarean delivery.. · Rate of vaginal delivery was high when labor was attempted.. · Both clinical and non-clinical factors were associated with risk of cesarean delivery..
Collapse
Affiliation(s)
- Katherine Underwood
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale School of Medicine, New Haven, Connecticut
| | - Uma M Reddy
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale School of Medicine, New Haven, Connecticut
| | - Hillary Hosier
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale School of Medicine, New Haven, Connecticut
| | - Lena Sweeney
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale School of Medicine, New Haven, Connecticut
| | - Katherine H Campbell
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale School of Medicine, New Haven, Connecticut
| | - Xiao Xu
- Department of Obstetrics, Gynecology, and Reproductive Sciences, Yale School of Medicine, New Haven, Connecticut
| |
Collapse
|
2
|
Peterwerth NH, Halek M, Schäfers R. Association of personal and systemic factors on intrapartum risk perception and obstetric intervention rates: a cross-sectional study. BMC Pregnancy Childbirth 2024; 24:155. [PMID: 38389073 PMCID: PMC10882933 DOI: 10.1186/s12884-024-06338-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/21/2023] [Accepted: 02/09/2024] [Indexed: 02/24/2024] Open
Abstract
BACKGROUND Risk perception is fundamental to decision-making; therefore its exploration is essential to gaining a comprehensive understanding of the decision-making process for peripartum interventions. The aim of this study was to investigate associations between personal and systemic factors of the work setting and the risk perception of obstetric healthcare professionals, and in turn how this might influence decisions regarding obstetric interventions. METHODS Case vignettes were used to measure risk perception. A quantitative cross-sectional online survey was performed within an exploratory sequential mixed-methods design, and an intervention readiness score created. Associations were calculated using location and dispersion measures, t-tests and correlations in addition to multiple linear regression. RESULTS Risk perception, as measured by the risk assessment score, was significantly lower (average 0.8 points) for midwives than for obstetricians (95%-CI [-0.673; -0.317], p < .001). Statistically significant correlations were found for: years of experience and annual number of births in the current workplace, but this was not clinically relevant; hours worked, with the groups of participants working ≥ 30,5 h showing a statistically significant higher risk perception than participants working 20,5-30 h (p = .005); and level of care of the current workplace, with the groups of participants working in a birth clinic (Level IV) showing a statistically significant lower risk perception than participants working in Level I hospital (highly specialised obstetric and neonatal care; p = .016). The option of midwife-led birthing care showed no correlation with risk perception. The survey identified that risk perception, occupation, years in the profession and number of hours worked (i.e. full or part time) represent significant influences on obstetric healthcare professionals' willingness to intervene. CONCLUSIONS The results of the survey give rise to the hypothesis that the personal and systemic factors of professional qualification, occupation, number of hours worked and level of acuity of the workplace are related to the risk perception of obstetric healthcare professionals. In turn, risk perception itself made a significant contribution to explaining differences in willingness to intervene, suggesting that it influences obstetricians' and midwives' decision-making. Overall, however, the correlations were weak and should be interpreted cautiously. The significant variations in the use of interventions must be addressed in order to provide the highest quality and best possible care for childbearing women and their families. To this end, developing strategies to improve interdisciplinary relationships and collaboration is of great importance. TRIAL REGISTRATION German Clinical Trials Register DRKS00017172 (18.06.2019).
Collapse
Affiliation(s)
- Nina H Peterwerth
- Department of Applied Health Sciences - Midwifery, University of Applied Sciences-Hochschule für Gesundheit, Gesundheitscampus 6-8, 44801, Bochum, Germany.
- School of Nursing Science, Faculty of Health, Department für Pflegewissenschaft, Fakultät für Gesundheit, Witten/Herdecke University, Alfred-Herrhausen-Straße 50, 58455, Witten, Germany.
| | - Margareta Halek
- School of Nursing Science, Faculty of Health, Department für Pflegewissenschaft, Fakultät für Gesundheit, Witten/Herdecke University, Alfred-Herrhausen-Straße 50, 58455, Witten, Germany
| | - Rainhild Schäfers
- Institute of Midwifery Science, Faculty of Medicine, University of Münster, Malmedyweg 17-19, 48149, Münster, Germany
| |
Collapse
|
3
|
Pfniss I, Gold D, Holter M, Schöll W, Berger G, Greimel P, Lang U, Reif P. Birth during off-hours: Impact of time of birth, staff´s seniority, and unit volume on maternal adverse outcomes-a population-based cross-sectional study of 87 065 deliveries. Birth 2022; 50:449-460. [PMID: 35789033 DOI: 10.1111/birt.12663] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/06/2020] [Accepted: 06/13/2022] [Indexed: 11/29/2022]
Abstract
BACKGROUND The aim of this study was to investigate whether time of birth, unit volume, and staff seniority impact the incidence of maternal complications in deliveries ≥34 + 0 gestational weeks. METHODS We conducted a population-based cross-sectional study of 87 065 deliveries occurring between 2004 and 2015 in ten public hospitals in Styria, Austria. A composite adverse maternal outcome measure of uterine atony, postpartum hysterectomy, postpartum bleeding, impaired wound healing, postpartum infections requiring antibiotic treatment, sepsis, or maternal death was used to compare outcomes by time of birth, unit volume, and staff seniority. Based on delivery data, generalized estimating equations (GEEs) were used to calculate the risk of maternal adverse outcomes. RESULTS Maternal adverse events occurred in 1.33% of deliveries. Incidence of maternal adverse events was highest for units with >1000 deliveries (adjusted OR 1.40; CI 95%: 1.16-1.69) and higher for perinatal centers (adjusted OR 1.35; CI 95%: 1.15-1.57) compared with reference units (500-1000 deliveries/year). Delivery during the daytime compared with the afternoon and nighttime did not affect the incidence of maternal complications (P = 0.765 and P = 0.136, respectively). Compared with resident-guided deliveries, the odds ratio for an adverse event was the same when a consultant attended the delivery (adjusted OR 1.13; CI 95%: 0.98-1.30) but lower in deliveries managed by midwives only (adjusted OR 0.21; CI 95%: 0.07-0.64). CONCLUSION Procedures performed during the night shift were not associated with increased complication rates. Delivery volume and high-volume centers were associated with the highest risk of maternal complications, and units with 500-1000 deliveries per year were the lowest. With increasing odds of pregnancy risks, these results change, and delivering in a high-volume center becomes at least as safe as delivering in a smaller unit.
Collapse
Affiliation(s)
- Isabella Pfniss
- Department of Gynecology, Hospital of the Hospitaller Order of Saint John of God, Graz, Austria
| | - Daniela Gold
- Department of Obstetrics and Gynecology, Medical University of Graz, Graz, Austria
| | - Magdalena Holter
- Institute for Medical Informatics, Statistics and Documentation, Medical University of Graz, Graz, Austria
| | - Wolfgang Schöll
- Department of Obstetrics and Gynecology, Medical University of Graz, Graz, Austria
| | - Gerhard Berger
- Department of Obstetrics and Gynecology, Hospital Hartberg, Hartberg, Austria
| | - Patrick Greimel
- Department of Obstetrics and Gynecology, Medical University of Graz, Graz, Austria
| | - Uwe Lang
- Department of Obstetrics and Gynecology, Medical University of Graz, Graz, Austria
| | - Philipp Reif
- Department of Obstetrics and Gynecology, Medical University of Graz, Graz, Austria
| |
Collapse
|
4
|
Telford M, Harding C, Stewart I, McGirr J, Seal A. Giving birth in the Murrumbidgee region: A quantitative and qualitative approach to general practice obstetrics in a rural region. Aust J Rural Health 2022; 30:512-519. [PMID: 35384121 PMCID: PMC9544910 DOI: 10.1111/ajr.12867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2021] [Revised: 11/16/2021] [Accepted: 03/07/2022] [Indexed: 11/29/2022] Open
Abstract
Objective There is public concern regarding rural workforce shortages and closure of smaller obstetric centres. Aim To identify whether safety is a concern for Murrumbidgee hospitals that fit primary medical care models and ascertain general practitioner (GP) obstetricians’ perspectives regarding the benefits and challenges to practising in the region. Design Mixed‐method retrospective analysis of selected outcomes in the NSW Mothers and Babies Reports 2012–2015 and semi‐structured interviews with GP obstetricians. Setting Murrumbidgee Local Health District. Main outcome measures Evaluation of the safety of smaller hospitals (i.e. discharge status at birth, neonatal resuscitation and admission to intensive care); and iterative thematic analysis. Results This study provides evidence that smaller hospitals are providing safe obstetric care. Fewer babies were transferred, with fewer stillbirths, at the smaller hospitals and no difference in newborn deaths. There were more normal vaginal births in the smaller hospitals (70.0%) than in Wagga Wagga Base Hospital (57.2%) or Griffith Base Hospital (58.6%). There were fewer neonatal resuscitations in the smaller hospitals than in Wagga Wagga Base Hospital or Griffith Base Hospital. More than one‐quarter of babies were admitted into the special care/neonatal intensive care for both Wagga Wagga and Griffith Base Hospitals; however, the rate was <3% in the smaller hospitals (p < 0.001). GPs were overwhelmingly positive about the professional rewards of GP obstetric practice and the importance of continuity of care, despite barriers such as workforce shortages, loss of facilities and other staff (midwives and anaesthetists). Possible solutions included fostering support systems, proactive succession planning and improving training support. Conclusions GP obstetricians are providing a valuable, safe service in MLHD with both personal and community benefits.
Collapse
Affiliation(s)
- Megan Telford
- School of Medicine Sydney, Rural Clinical School (Wagga), The University of Notre Dame Australia, Wagga Wagga, New South Wales, Australia
| | - Catherine Harding
- School of Medicine Sydney, Rural Clinical School (Wagga), The University of Notre Dame Australia, Wagga Wagga, New South Wales, Australia
| | - Ian Stewart
- School of Medicine Sydney, Rural Clinical School (Wagga), The University of Notre Dame Australia, Wagga Wagga, New South Wales, Australia
| | - Joe McGirr
- School of Medicine Sydney, Rural Clinical School (Wagga), The University of Notre Dame Australia, Wagga Wagga, New South Wales, Australia
| | - Alexa Seal
- School of Medicine Sydney, Rural Clinical School (Wagga), The University of Notre Dame Australia, Wagga Wagga, New South Wales, Australia
| |
Collapse
|
5
|
van den Berg LMM, Gordon BBM, Kleefstra SM, Martijn L, van Dillen J, Verhoeven CJ, de Jonge A. Centralisation of acute obstetric care in the Netherlands: a qualitative study to explore the experiences of stakeholders with adaptations in organisation of care. BMC Health Serv Res 2021; 21:1233. [PMID: 34774037 PMCID: PMC8590329 DOI: 10.1186/s12913-021-07269-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2021] [Accepted: 10/26/2021] [Indexed: 11/27/2022] Open
Abstract
Background In the past decade, acute obstetric care (AOC) has become centralised in many high-income countries. In this qualitative study, we explored how stakeholders in maternity care perceived and experienced adaptations in the organisation of maternity care in areas in the Netherlands where AOC was centralised. Methods A heterogenic group of fifteen maternity care stakeholders, including patients, were purposively selected for semi-structured interviews. An inductive thematic analysis was used. Results Three main themes were identified: (1) lack of involvement. (2) the process of making adaptations in the organisation of maternity care. (3) maintaining quality of care. Stakeholders in this study were highly motivated to maintain a high quality of maternity care and therefore made adaptations at several organisational levels. However, they felt a lack of involvement during the planning of centralisation of AOC and highlighted the importance of a collaborative process when making adaptations after centralisation of AOC. Conclusions Regions with AOC centralisation plans should invest time and money in change management, encourage early involvement of all maternity care stakeholders and acknowledge centralisation of AOC as a professional life event with associated emotions, including a feeling of unsafety. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-021-07269-4.
Collapse
Affiliation(s)
- Lauri M M van den Berg
- Department of Midwifery Science, AVAG/Amsterdam Public Health, Amsterdam University Medical Centre, Vrije Universiteit Amsterdam, Van der Boechorststraat 7, 1081 BT, Amsterdam, the Netherlands.
| | - Bernardus Benjamin Maria Gordon
- Department of Obstetrics and Gynaecology, Radboud University Medical Centre, Geert Grooteplein Zuid 10, 6523 GA, Nijmegen, the Netherlands
| | - Sophia M Kleefstra
- Dutch Health and Youth Care Inspectorate, Stadsplateau 1, 3521 AZ, Utrecht, the Netherlands
| | - Lucie Martijn
- Dutch Health and Youth Care Inspectorate, Stadsplateau 1, 3521 AZ, Utrecht, the Netherlands
| | - Jeroen van Dillen
- Department of Obstetrics and Gynaecology, Radboud University Medical Centre, Geert Grooteplein Zuid 10, 6523 GA, Nijmegen, the Netherlands
| | - Corine J Verhoeven
- Department of Midwifery Science, AVAG/Amsterdam Public Health, Amsterdam University Medical Centre, Vrije Universiteit Amsterdam, Van der Boechorststraat 7, 1081 BT, Amsterdam, the Netherlands.,Maxima Medical Centre, Department of Obstetrics and Gynecology, De Run 4600, Veldhoven, Netherlands.,Division of Midwifery, School of Health Sciences, University of Nottingham, Floor 12, Tower Building, University Park, NG7 2RD, Nottingham, UK
| | - Ank de Jonge
- Department of Midwifery Science, AVAG/Amsterdam Public Health, Amsterdam University Medical Centre, Vrije Universiteit Amsterdam, Van der Boechorststraat 7, 1081 BT, Amsterdam, the Netherlands
| |
Collapse
|
6
|
Hunter A, Banaag A, Lutgendorf MA, Staat CB, Koehlmoos TP. Volume as an Indicator for Outcomes for Severe Maternal Morbidity in the Military Health System. Mil Med 2021; 187:e963-e968. [PMID: 34741453 DOI: 10.1093/milmed/usab442] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2021] [Revised: 09/09/2021] [Accepted: 10/15/2021] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Maternal obstetric morbidity is a growing concern in the USA, where rates of maternal morbidity exceed Europe and most developed countries. Prior studies have found that obstetric case volume affects maternal morbidity, with low-volume facilities having higher rates of morbidity. However, these studies were done in civilian healthcare systems that are different from the Military Health System (MHS). This study evaluates whether obstetric case volume impacts severe maternal morbidity (SMM) in military hospitals located in the continental United States. METHODS This cross-sectional study included all military treatment facilities (MTFs) (n = 35) that performed obstetric deliveries (n = 102,959) from October 2015 to September 2018. Data were collected from the MHS Data Repository and identified all deliveries for the study time period. Severe maternal morbidity was defined by the Centers for Disease Control. The 30-day readmission rates were also included in analysis. Military treatment facilities were separated into volume quartiles for analysis. Univariate logistic regressions were performed to determine the impact of MTF delivery volume on the probability of SMM and 30-day maternal readmissions. RESULTS The results for all regression models indicate that the MTF delivery volume had no significant impact on the probability of SMM. With regard to 30-day maternal readmissions, using the upper middle quartile as the comparison group due to the largest number of deliveries, MTFs in the lower middle quartile and in the highest quartile had a statistically significant higher likelihood of 30-day maternal readmissions. CONCLUSION This study shows no difference in SMM rates in the MHS based on obstetric case volume. This is consistent with previous studies showing differences in MHS patient outcomes compared to civilian healthcare systems. The MHS is unique in that it provides families with universal healthcare coverage and access and provides care for approximately 40,000 deliveries annually. There may be unique lessons on volume and outcomes in the MHS that can be shared with healthcare planners and decision makers to improve care in the civilian setting.
Collapse
Affiliation(s)
- Aimee Hunter
- Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
| | - Amanda Banaag
- Henry M. Jackson Foundation for the Advancement in Military Medicine, Inc., Bethesda, MD 20817, USA
| | - Monica A Lutgendorf
- Department of Gynecologic Surgery and Obstetrics, Naval Medical Center San Diego, San Diego, CA 92314, USA.,Department of Gynecologic Surgery and Obstetrics, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
| | - Col Barton Staat
- Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
| | - Tracey P Koehlmoos
- Department of Preventive Medicine and Biostatistics, Uniformed Services University of the Health Sciences, Bethesda, MD 20814, USA
| |
Collapse
|
7
|
Stewart RA. Birthing: A vital service for rural communities Perspectives from the National Rural Health Commissioner. Aust N Z J Obstet Gynaecol 2021; 61:647-649. [PMID: 34655086 DOI: 10.1111/ajo.13421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2021] [Accepted: 08/01/2021] [Indexed: 10/20/2022]
Affiliation(s)
- Ruth A Stewart
- National Rural Health Commissioner, Department of Health, Cairns, Queensland, Australia
| |
Collapse
|
8
|
Daily patient flow unevenness in different sized delivery hospitals - An 11-year register study of 610 227 deliveries. Eur J Obstet Gynecol Reprod Biol 2021; 266:187-190. [PMID: 34563418 DOI: 10.1016/j.ejogrb.2021.09.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 09/08/2021] [Indexed: 11/22/2022]
Abstract
OBJECTIVES To describe the unevenness in daily patient flow (quiet, optimal and busy days) in different sized delivery hospitals. STUDY DESIGN Population based register-study of 610 227 hospital deliveries. Data were collected from the Finnish Medical Birth Register from 2006 to 2016. Delivery hospitals (N = 26) were stratified into four categories by annual delivery volume: C1 <1000, C2 1000-1999, C3 2000-2999, C4 ≥3000. Uneven daily patient flow was defined based on the mean of daily delivery volume for each hospital category: quiet day (≤50% of the mean), optimal day (>50% of the mean to <two times the mean) and busy day (≥two times the mean or more). RESULTS The mean of daily delivery volume varied from 2.0 to 12.6 between the smallest and the largest hospital, respectively in hospital categories C1 and C4. The daily delivery volume was optimal in 41.2%, 68.3%, 84.0%, and 91.0% of the days in hospital categories C1, C2, C3, and C4, respectively. In the smallest hospitals (C1) almost half of the days appeared to be quiet (42.9%) whereas in the larger hospitals approximately one in four (25.4%), one in seven (13.6%), and less than one in ten of the days were quiet, in the categories C2, C3, and C4 respectively. Busy days were most common in the smallest hospitals (C1) where one in six of the day (15.9%) had daily delivery volume ≥two times the mean or more. In the other hospital categories busy days were rare, and the lowest in the largest hospitals. CONCLUSIONS Unevenness in daily patient flow was more prominent in the smaller delivery units compared to larger ones. Quiet and busy days both caused challenges to delivery unit organisations. During quiet days, fully over-resourcing of staffing occurred whereas during busy days there was a risk of under-resourcing. It is possible to optimise the size of delivery units to minimise the variation of the daily patient flow to decrease the number of quiet and busy days.
Collapse
|
9
|
Walther F, Kuester D, Bieber A, Malzahn J, Rüdiger M, Schmitt J. Are birth outcomes in low risk birth cohorts related to hospital birth volumes? A systematic review. BMC Pregnancy Childbirth 2021; 21:531. [PMID: 34315416 PMCID: PMC8314545 DOI: 10.1186/s12884-021-03988-y] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 07/02/2021] [Indexed: 01/08/2023] Open
Abstract
Background There is convincing evidence that birth in hospitals with high birth volumes increases the chance of healthy survival in high-risk infants. However, it is unclear whether this is true also for low risk infants. The aim of this systematic review was to analyze effects of hospital’s birth volume on mortality, mode of delivery, readmissions, complications and subsequent developmental delays in all births or predefined low risk birth cohorts. The search strategy included EMBASE and Medline supplemented by citing and cited literature of included studies and expert panel highlighting additional literature, published between January/2000 and February/2020. We included studies which were published in English or German language reporting effects of birth volumes on mortality in term or all births in countries with neonatal mortality < 5/1000. We undertook a double-independent title-abstract- and full-text screening and extraction of study characteristics, critical appraisal and outcomes in a qualitative evidence synthesis. Results 13 retrospective studies with mostly acceptable quality were included. Heterogeneous volume-thresholds, risk adjustments, outcomes and populations hindered a meta-analysis. Qualitatively, four of six studies reported significantly higher perinatal mortality in lower birth volume hospitals. Volume-outcome effects on neonatal mortality (n = 7), stillbirths (n = 3), maternal mortality (n = 1), caesarean sections (n = 2), maternal (n = 1) and neonatal complications (n = 1) were inconclusive. Conclusion Analyzed studies indicate higher rates of perinatal mortality for low risk birth in hospitals with low birth volumes. Due to heterogeneity of studies, data synthesis was complicated and a meta-analysis was not possible. Therefore international core outcome sets should be defined and implemented in perinatal registries. Systematic review registration PROSPERO: CRD42018095289 Supplementary Information The online version contains supplementary material available at 10.1186/s12884-021-03988-y.
Collapse
Affiliation(s)
- Felix Walther
- Center for Evidence-Based Healthcare, Medical Faculty Carl Gustav Carus, TU Dresden, Fetscherstraße 74, 01307, Dresden, Germany. .,Quality and Medical Risk Management, University Hospital Carl, Gustav Carus, Fetscherstraße 74, 01307, Dresden, Germany.
| | - Denise Kuester
- Center for Evidence-Based Healthcare, Medical Faculty Carl Gustav Carus, TU Dresden, Fetscherstraße 74, 01307, Dresden, Germany
| | - Anja Bieber
- Institute of Health and Nursing Science, Medical Faculty, Martin Luther University Halle-Wittenberg, Postfach 302, 06097, Halle, Saale, Germany
| | - Jürgen Malzahn
- Federation of Local Health Insurance Funds, Clinical Care, Rosenthaler Str. 31, 10178, Berlin, Germany
| | - Mario Rüdiger
- Department for Neonatology and Pediatric Intensive Care, University Hospital Carl Gustav Carus, Technische Universität Dresden, Fetscherstraße 74, 01307, Dresden, Germany.,Medical Faculty Carl Gustav Carus, Saxony Center for Feto-Neonatal Health, TU Dresden, Fetscherstraße 74, 01307, Dresden, Germany
| | - Jochen Schmitt
- Center for Evidence-Based Healthcare, Medical Faculty Carl Gustav Carus, TU Dresden, Fetscherstraße 74, 01307, Dresden, Germany.,Medical Faculty Carl Gustav Carus, Saxony Center for Feto-Neonatal Health, TU Dresden, Fetscherstraße 74, 01307, Dresden, Germany
| |
Collapse
|
10
|
Tennett D, Kearney L, Kynn M. Access and outcomes of general practitioner obstetrician (rural generalist)-supported birthing units in Queensland. Aust J Rural Health 2020; 28:42-50. [PMID: 31903661 PMCID: PMC7328769 DOI: 10.1111/ajr.12593] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2019] [Revised: 10/27/2019] [Accepted: 10/30/2019] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVE To describe characteristics and outcomes of women birthing within GP-obstetrician (rural generalist) supported rural (level 3) obstetric units in Queensland. DESIGN Retrospective descriptive study. SETTING 21 GP-obstetrician supported birthing units in Queensland. PARTICIPANTS Women (n = 3111) birthing from January 2017 to December 2017. MAIN OUTCOME MEASURES Patient, pregnancy and labour characteristics and key maternal and neonatal outcomes routinely recorded in the Queensland Perinatal Data Collection and Queensland Hospital Admitted Patient Data Collection were compared to Queensland public hospital aggregate data. RESULTS Women birthing in rural maternity units were significantly more likely to be Aboriginal or Torrs Strait Islander (16% v 9%), < 20 years old (7% v 4%), term deliveries (96% v 91%), achieve spontaneous onset of labour (67% v 51%), and birth (71% v 60%) (p<0.001) compared with all Queensland public hospitals. They were significantly less likely to be nulliparous (36% v 40%), use pharmacological analgesia (65% v 69%), or have continuous electronic fetal monitoring in labour (54% v 66%) (p<0.001). Neonatal outcomes were comparable; with no significant difference in stillbirth rate between rural units and all Queensland public hospitals (4.8 v 7.3 per 1000 births). Precipitate delivery was the most common labour complication (36% v 33%) (p<0.001). CONCLUSION GP-obstetrician (rural generalist) supported rural birthing units in Queensland provide important access for low and medium risk women to deliver locally, with strong indicators of quality and safety.
Collapse
Affiliation(s)
- Debra Tennett
- Gympie HospitalSunshine Coast Hospital and Health ServiceGympieQueenslandAustralia
| | - Lauren Kearney
- School of Nursing, Midwifery and ParamedicineUniversity of the Sunshine CoastMaroochydore DCQueenslandAustralia
| | - Mary Kynn
- School of Health and Sports SciencesUniversity of the Sunshine CoastMaroochydore DCQueenslandAustralia
| |
Collapse
|
11
|
Lefèvre M, Van den Heede K, Camberlin C, Bouckaert N, Beguin C, Devos C, Van de Voorde C. Impact of shortened length of stay for delivery on the required bed capacity in maternity services: results from forecast analysis on administrative data. BMC Health Serv Res 2019; 19:637. [PMID: 31488147 PMCID: PMC6729074 DOI: 10.1186/s12913-019-4500-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/13/2019] [Accepted: 08/30/2019] [Indexed: 11/24/2022] Open
Abstract
BACKGROUND We examine the implications of reducing the average length of stay (ALOS) for a delivery on the required capacity in terms of service volume and maternity beds in Belgium, using administrative data covering all inpatient stays in Belgian general hospitals over the period 2003-2014. METHODS A projection model generates forecasts of all inpatient and day-care services with a time horizon of 2025. It adjusts the observed hospital use in 2014 to the combined effect of three evolutions: the change in population size and composition, the time trend evolution of ALOS, and the time trend evolution of the admission rates. In addition, we develop an alternative scenario to evaluate the impact of an accelerated reduction of ALOS. RESULTS Between 2014 and 2025, we expect the number of deliveries to increase by 4.41%, and the number of stays in maternity services by 3.38%. At the same time, a reduction in ALOS is projected for all types of deliveries. The required capacity for maternity beds will decrease by 17%. In case of an accelerated reduction of the ALOS to reach international standards, this required capacity for maternity beds will decrease by more than 30%. CONCLUSIONS Despite an expected increase in the number of deliveries, future hospital capacity in terms of maternity beds can be considerably reduced in Belgium, due to the continuing reduction of ALOS.
Collapse
Affiliation(s)
- Mélanie Lefèvre
- Belgian Health Care Knowledge Centre (KCE), Doorbuilding, Boulevard du Jardin Botanique 55, 1000 Bruxelles, Belgium
| | - Koen Van den Heede
- Belgian Health Care Knowledge Centre (KCE), Doorbuilding, Boulevard du Jardin Botanique 55, 1000 Bruxelles, Belgium
| | - Cécile Camberlin
- Belgian Health Care Knowledge Centre (KCE), Doorbuilding, Boulevard du Jardin Botanique 55, 1000 Bruxelles, Belgium
| | - Nicolas Bouckaert
- Belgian Health Care Knowledge Centre (KCE), Doorbuilding, Boulevard du Jardin Botanique 55, 1000 Bruxelles, Belgium
| | - Claire Beguin
- Belgian Health Care Knowledge Centre (KCE), Doorbuilding, Boulevard du Jardin Botanique 55, 1000 Bruxelles, Belgium
| | - Carl Devos
- Belgian Health Care Knowledge Centre (KCE), Doorbuilding, Boulevard du Jardin Botanique 55, 1000 Bruxelles, Belgium
| | - Carine Van de Voorde
- Belgian Health Care Knowledge Centre (KCE), Doorbuilding, Boulevard du Jardin Botanique 55, 1000 Bruxelles, Belgium
| |
Collapse
|
12
|
Hoxha I, Braha M, Syrogiannouli L, Goodman DC, Jüni P. Caesarean section in uninsured women in the USA: systematic review and meta-analysis. BMJ Open 2019; 9:e025356. [PMID: 30833323 PMCID: PMC6443081 DOI: 10.1136/bmjopen-2018-025356] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2018] [Revised: 11/14/2018] [Accepted: 12/19/2018] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVE The aim of this study is to assess the odds of caesarean section (CS) for uninsured women in the USA and understand the underlying mechanisms as well as consequences of lower use. STUDY DESIGN Systematic review and meta-analysis. DATA SOURCES PubMed, Embase, the Cochrane Library and CINAHL from the first year of records to April 2018. ELIGIBILITY CRITERIA We included studies that reported data to allow the calculation of ORs of CS of uninsured as compared with insured women. OUTCOMES The prespecified primary outcome was the adjusted OR of deliveries by CS of uninsured women as compared with privately or publicly insured women. The prespecified secondary outcome was the crude OR of deliveries by CS of uninsured women as compared with insured women. RESULTS 12 articles describing 16 separate studies involving more than 8.8 million women were included in this study. We found: 0.70 times lower odds of CS in uninsured as compared with privately insured women (95% CI 0.63 to 0.78), with no relevant heterogeneity between studies (τ2=0.01); and 0.92 times lower odds for CS in uninsured as compared with publicly insured women (95% CI 0.80 to 1.07), with no relevant heterogeneity between studies (τ2=0.02). We found 0.70 times lower odds in uninsured as compared with privately and publicly insured women (95% CI 0.69 to 0.72). CONCLUSIONS CSs are less likely to be performed in uninsured women as compared with insured women. While the higher rates for CS among privately insured women can be explained with financial incentives associated with private insurance, the lower odds among uninsured women draw attention at barriers to access for delivery care. In many regions, the rates for uninsured women are above, close or below the benchmarks for appropriate CS rates and could imply both, underuse and overuse.
Collapse
Affiliation(s)
- Ilir Hoxha
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- Department of Community & Family Medicine, Geisel School of Medicine at Dartmouth Hanover, New Hampshire, USA
- Heimerer College, Prishtina, Kosovo
| | - Medina Braha
- International Business College Mitrovica, Mitrovica, Kosovo
| | | | - David C Goodman
- Institute of Social and Preventive Medicine, University of Bern, Bern, Switzerland
- The Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, USA
| | - Peter Jüni
- Applied Health Research Centre (AHRC), Li Ka Shing Knowledge Institute of St. Michael’s Hospital, Department of Medicine, and Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
| |
Collapse
|
13
|
Montagu D, Sudhinaraset M, Diamond-Smith N, Campbell O, Gabrysch S, Freedman L, Kruk ME, Donnay F. Where women go to deliver: understanding the changing landscape of childbirth in Africa and Asia. Health Policy Plan 2018; 32:1146-1152. [PMID: 28541422 PMCID: PMC5886217 DOI: 10.1093/heapol/czx060] [Citation(s) in RCA: 90] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/30/2017] [Indexed: 11/13/2022] Open
Abstract
Growing evidence from a number of countries in Asia and Africa documents a large shift towards facility deliveries in the past decade. These increases have not led to the improvements in health outcomes that were predicted by health policy researchers in the past. In light of this unexpected evidence, we have assessed data from multiple sources, including nationally representative data from 43 countries in Asia and Africa, to understand the size and range of changing delivery location in Asia and Africa. We have reviewed the policies, programs and financing experiences in multiple countries to understand the drivers of changing practices, and the consequences for maternal and neonatal health and the health systems serving women and newborns. And finally, we have considered what implications changes in delivery location will have for maternal and neonatal care strategies as we move forward into the next stage of global action. As a result of our analysis we make four major policy recommendations. (1) An expansion of investment in mid-level facilities for delivery services and a shift away from low-volume rural delivery facilities. (2) Assured access for rural women through funding for transport infrastructure, travel vouchers, targeted subsidies for services and residence support before and after delivery. (3) Increased specialization of maternity facilities and dedicated maternity wards within larger institutions. And (4) a renewed focus on quality improvements at all levels of delivery facilities, in both private and public settings.
Collapse
Affiliation(s)
- Dominic Montagu
- Department of Epidemiology and Biostatistics, Global Health Sciences, University of California, San Francisco; San Francisco, CA, USA
| | - May Sudhinaraset
- Department of Epidemiology and Biostatistics, Global Health Sciences, University of California, San Francisco; San Francisco, CA, USA.,Community Health Sciences; University of California, Los Angeles; Los Angeles, CA, USA
| | - Nadia Diamond-Smith
- Department of Epidemiology and Biostatistics, Global Health Sciences, University of California, San Francisco; San Francisco, CA, USA
| | - Oona Campbell
- London School of Hygiene and Tropical Medicine, London, UK
| | | | - Lynn Freedman
- Population and Family Health, Columbia University, New York, NY, USA
| | - Margaret E Kruk
- Department of Global Health and Population, Harvard University, Cambridge, MA, USA
| | - France Donnay
- School of Public Health and Tropical Medicine, Tulane University, New Orleans, Louisiana, USA
| |
Collapse
|
14
|
Identifying better systems design in Australian maternity care: a Boundary Critique analysis. Health Syst (Basingstoke) 2017. [DOI: 10.1057/hs.2013.7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
|
15
|
Reif P, Pichler G, Griesbacher A, Lehner G, Schöll W, Lang U, Hofmann H, Ulrich D. Do time of birth, unit volume, and staff seniority affect neonatal outcome in deliveries at ≥34
+0
weeks of gestation? BJOG 2017; 125:884-891. [DOI: 10.1111/1471-0528.15000] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/13/2017] [Indexed: 11/27/2022]
Affiliation(s)
- P Reif
- Department of Obstetrics and Gynaecology Medical University of Graz Graz Austria
| | - G Pichler
- Division of Neonatology Department of Paediatrics Medical University of Graz Graz Austria
| | - A Griesbacher
- Risk Assessment, Data and Statistics Austrian Agency for Health and Food Safety Graz Austria
| | - G Lehner
- Department of Obstetrics and Gynaecology Medical University of Graz Graz Austria
| | - W Schöll
- Department of Obstetrics and Gynaecology Medical University of Graz Graz Austria
| | - U Lang
- Department of Obstetrics and Gynaecology Medical University of Graz Graz Austria
| | - H Hofmann
- Department of Obstetrics and Gynaecology Hospital Feldbach Feldbach Austria
| | - D Ulrich
- Department of Obstetrics and Gynaecology Medical University of Graz Graz Austria
| |
Collapse
|
16
|
Increased risk of peripartum perinatal mortality in unplanned births outside an institution: a retrospective population-based study. Am J Obstet Gynecol 2017; 217:210.e1-210.e12. [PMID: 28390672 DOI: 10.1016/j.ajog.2017.03.033] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/17/2016] [Revised: 03/18/2017] [Accepted: 03/29/2017] [Indexed: 11/22/2022]
Abstract
BACKGROUND Births in midwife-led institutions may reduce the frequency of medical interventions and provide cost-effective care, while larger institutions offer medically and technically advanced obstetric care. Unplanned births outside an institution and intrapartum stillbirths have frequently been excluded in previous studies on adverse outcomes by place of birth. OBJECTIVE The objective of the study was to assess peripartum mortality by place of birth and travel time to obstetric institutions, with the hypothesis that centralization reduces institution availability but improves mortality. STUDY DESIGN This was a national population-based retrospective cohort study of all births in Norway from 1999 to 2009 (n = 648,555) using data from the Medical Birth Registry of Norway and Statistics Norway and including births from 22 gestational weeks or birthweight ≥500 g. Main exposures were travel time to the nearest obstetric institution and place of birth. The main clinical outcome was peripartum mortality, defined as death during birth or within 24 hours. Intrauterine fetal deaths prior to start of labor were excluded from the primary outcome. RESULTS A total of 1586 peripartum deaths were identified (2.5 per 1000 births). Unplanned birth outside an institution had a 3 times higher mortality (8.4 per 1000) than institutional births (2.4 per 1000), relative risk, 3.5 (95% confidence interval, 2.5-4.9) and contributed 2% (95% confidence interval, 1.2-3.0%) of the peripartum mortality at the population level. The risk of unplanned birth outside an institution increased from 0.5% to 3.3% and 4.5% with travel time <1 hour, 1-2 hours, and >2 hours, respectively. In obstetric institutions the mortality rate at term ranged from 0.7 per 1000 to 0.9 per 1000. Comparable mortality rates in different obstetric institutions indicated well-functioning routines for referral. CONCLUSION Unplanned birth outside an institution was associated with increased peripartum mortality and with long travel time to obstetric institutions. Structural determinants have an important impact on perinatal health in high-income countries and also for low-risk births. The results show the importance of skilled birth attendance and warrant attention from clinicians and policy makers to negative consequences of reduced access to institutions.
Collapse
|
17
|
Tran T, Longman J, Kornelsen J, Barclay L. The development of a caseload midwifery service in rural Australia. Women Birth 2017; 30:291-297. [DOI: 10.1016/j.wombi.2016.11.010] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2016] [Revised: 11/18/2016] [Accepted: 11/23/2016] [Indexed: 11/27/2022]
|
18
|
Patterson J, Foureur M, Skinner J. Remote rural women's choice of birthplace and transfer experiences in rural Otago and Southland New Zealand. Midwifery 2017; 52:49-56. [PMID: 28600971 DOI: 10.1016/j.midw.2017.05.014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2017] [Revised: 05/14/2017] [Accepted: 05/23/2017] [Indexed: 11/16/2022]
Abstract
BACKGROUND Birth in primary midwife-led maternity units has been demonstrated to be a safe choice for well women anticipating a normal birth. The incidence of serious perinatal outcomes for these women is comparable to similarly low risk women, who choose to birth in hospital. New Zealand women have a choice of Lead Maternity Carer (LMC) and birthplace; home, primary birthing unit, or a base hospital, though not all women may have all these choices available locally. Women in rural and rural remote areas can also choose to birth in their rural primary maternity unit. A percentage of these women (approx. 15-17%) will require transfer during labour, an event which can cause distress and often loss of midwifery continuity of care. OBJECTIVE To explore retrospectively the choice of birth place decisions and the labour and birth experiences of a sample of women resident in remotely zoned, rural areas of the lower South Island of New Zealand. DESIGN A purposive sample of women living in remote rural areas, recruited by advertising in local newspapers and flyers. Individual semi-structured interviews were digitally recorded using a pragmatic interpretive approach. The data (transcripts and field notes) were analysed using thematic and content analysis. Ethical approval was obtained from the Health and Disability Ethics Committee (HEDC) MEC/06/05/045. PARTICIPANTS Thirteen women consented to participate. Each was resident in a remote rural area having given birth in the previous 18 months. The women had been well during their pregnancies and at the onset of labour had anticipated a spontaneous vaginal birth. SETTING Rural remote zoned areas in Otago and Southland in the South Island of New Zealand FINDINGS: Five women planned to birth in a regional hospital and eight chose their nearest rural primary maternity unit. All of the women were aware of the possibility of transfer and had made their decision about their birthplace based on their perception of their personal safety, and in consideration of their distance from specialist care. Themes included, deciding about the safest place to give birth; making the decision to transfer; experiencing transfer in labour, and reflecting on their birth experience and considering future birthplace choices. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE AND POLICY The experiences of the women show that for some, distance from a base hospital influences their place of birth decisions in remote rural areas of New Zealand and increases the distress for those needing to transfer over large distances. These experiences can result in women choosing, or needing to make different choices for subsequent births; the consequences of which impact on the future sustainability of midwifery services in remote rural areas, a challenge which resonates with maternity service provision internationally. While choices about birth place cannot be reliably predicted, creative solutions are needed to provide rural midwifery care and birth options for women and more timely and efficient transfer services when required.
Collapse
Affiliation(s)
- Jean Patterson
- School of Midwifery, Otago Polytechnic, Forth Street, Private Bag 1910, 9054 Dunedin, New Zealand.
| | - Maralyn Foureur
- Centre for Midwifery, Child and Family Health, Faculty of Health, University of Technology Sydney, Level 8, Building 10, City Campus, PO Box 123, Broadway, NSW 2007, Australia.
| | - Joan Skinner
- Commonlife Ltd, 10A London d, Korokoro, Lower Hutt 5012, New Zealand.
| |
Collapse
|
19
|
Haines HM, Baker J, Marshall D. Continuity of midwifery care for rural women through caseload group practice: Delivering for almost 20 years. Aust J Rural Health 2017; 23:339-45. [PMID: 26683716 DOI: 10.1111/ajr.12232] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/28/2015] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE To describe the clinical outcomes and sustainability factors of a long-standing midwifery led caseload model of rural maternity care. DESIGN Retrospective clinical audit from 1998 to 2011 and autoethnographic narrative of the midwifery program told by the longest serving midwives under three key themes relating to sustainable practice. SETTING Regional Health Service with annual birth rate of 500. Maternity care is provided by either public antenatal clinic/GP shared care or midwife-led care. PARTICIPANTS Women attending a rural caseload midwifery group practice between the period 1998-2011 and midwives working in the same group practice during that period. MAIN OUTCOME MEASURES Antenatal attendance, maternal mortality, infant morbidity and mortality, mode of birth, known midwife at birth, initiation of breastfeeding. RESULTS There were 1674 births between 1998 and 2011. Clinical outcomes for women and infants closely reflected national maternity indicator data. The group practice midwives attribute sustainability of the program to the enjoyment of flexibility in their working environment, to establishing trust amongst themselves, the women they care for, and with the obstetricians, GPs and health service executives. The rigorous application of midwifery principles including robust clinical governance have been hallmarks of success. CONCLUSION This caseload midwifery group practice is a safe, satisfying and sustainable model of maternity care in a rural setting. Clinical outcomes are similar to standard care. Success can be attributed to strong leadership across all levels of policy, health service management and, most importantly, the rural midwives providing the service.
Collapse
Affiliation(s)
- Helen M Haines
- Midwifery, Northeast Health Wangaratta, Wangaratta, Victoria, Australia.,Department of Rural Health, The University of Melbourne, Shepparton, Victoria, Australia
| | - Janet Baker
- Midwifery, Northeast Health Wangaratta, Wangaratta, Victoria, Australia
| | - Diana Marshall
- Midwifery, Northeast Health Wangaratta, Wangaratta, Victoria, Australia
| |
Collapse
|
20
|
Monk AR, Grigg CP, Foureur M, Tracy M, Tracy SK. Freestanding midwifery units: Maternal and neonatal outcomes following transfer. Midwifery 2017; 46:24-28. [PMID: 28126592 DOI: 10.1016/j.midw.2017.01.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2016] [Revised: 12/20/2016] [Accepted: 01/09/2017] [Indexed: 11/30/2022]
Abstract
BACKGROUND the viability of freestanding midwifery units in Australia is restricted, due to concerns over their safety, particularly for women and babies who, require transfer. AIM to compare the maternal and neonatal birth outcomes of women who planned, to give birth at freestanding midwifery units and subsequently, transferred to a tertiary maternity unit to the maternal and neonatal, outcomes of a low-risk cohort of women who planned to give birth in, tertiary maternity unit. METHODS a descriptive study compared two groups of women with low-risk singleton, pregnancies who were less than 28 weeks pregnant at booking: women who, planned to give birth at a freestanding midwifery unit (n=494) who, transferred to a tertiary maternity unit during the antenatal, intrapartum or postnatal periods (n=260) and women who planned to give, birth at a tertiary maternity unit (n=3157). Primary outcomes were mode, of birth, Apgar score of less than 7 at 5minutes and admission to, special care nursery or neonatal intensive care. KEY FINDINGS the proportion of women who experienced a caesarean section was lower, among the freestanding midwifery unit women who transferred during the, intrapartum/postnatal period compared to women in the tertiary maternity, unit group (16.1% versus 24.8% respectively). Other outcomes were, comparable between the cohorts. Rates of primary outcomes in relation to, stage of transfer varied when stratified by parity. DISCUSSION these descriptive results support the provision of care in freestanding, midwifery units as an alternative to tertiary maternity units for women, with low risk pregnancies at the time of booking. A larger study, powered, to determine statistical significance of any differences in outcomes, is, required.
Collapse
Affiliation(s)
- Amy R Monk
- F,aculty of Health, the University of Technology Sydney, PO Box 222, Ultimo, 2007 NSW, Australia.
| | - Celia P Grigg
- School of Health Sciences, Division of Midwifery, Floor 12, Tower Block, Park Campus, University of Nottingham, Nottingham NG7 2RD, England, UK
| | - Maralyn Foureur
- F,aculty of Health, the University of Technology Sydney, PO Box 222, Ultimo, 2007 NSW, Australia
| | - Mark Tracy
- Department of Paediatrics and Child Health, The University of Sydney, Sydney, 2050 NSW, Australia
| | - Sally K Tracy
- Midwifery and Women's Health Research Unit, The Royal Hospital for Women, Level 1, Barker Street, Randwick, 2031 NSW Australia
| |
Collapse
|
21
|
Shaw D, Guise JM, Shah N, Gemzell-Danielsson K, Joseph KS, Levy B, Wong F, Woodd S, Main EK. Drivers of maternity care in high-income countries: can health systems support woman-centred care? Lancet 2016; 388:2282-2295. [PMID: 27642026 DOI: 10.1016/s0140-6736(16)31527-6] [Citation(s) in RCA: 132] [Impact Index Per Article: 16.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2016] [Revised: 05/24/2016] [Accepted: 06/27/2016] [Indexed: 10/21/2022]
Abstract
In high-income countries, medical interventions to address the known risks associated with pregnancy and birth have been largely successful and have resulted in very low levels of maternal and neonatal mortality. In this Series paper, we present the main care delivery models, with case studies of the USA and Sweden, and examine the main drivers of these models. Although nearly all births are attended by a skilled birth attendant and are in an institution, practice, cadre, facility size, and place of birth vary widely; for example, births occur in homes, birth centres, midwifery-led birthing units in hospitals, and in high intervention hospital birthing facilities. Not all care is evidenced-based, and some care provision may be harmful. Fear prevails among subsets of women and providers. In some settings, medical liability costs are enormous, human resource shortages are common, and costs of providing care can be very high. New challenges linked to alteration of epidemiology, such as obesity and older age during pregnancy, are also present. Data are often not readily available to inform policy and practice in a timely way and surveillance requires greater attention and investment. Outcomes are not equitable, and disadvantaged segments of the population face access issues and substantially elevated risks. At the same time, examples of excellence and progress exist, from clinical interventions to models of care and practice. Labourists (who provide care for all the facility's women for labour and delivery) are discussed as a potential solution. Quality and safety factors are informed by women's experiences, as well as medical evidence. Progress requires the ability to normalise birth for most women, with integrated services available if complications develop. We also discuss mechanisms to improve quality of care and highlight areas where research can address knowledge gaps with potential for impact. Evaluation of models that provide woman-centred care and the best outcomes without high costs is required to provide an impetus for change.
Collapse
Affiliation(s)
- Dorothy Shaw
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, BC, Canada; Department of Medical Genetics, University of British Columbia, Vancouver, BC, Canada; BC Women's Hospital and Health Centre, Vancouver, BC, Canada.
| | - Jeanne-Marie Guise
- Departments of Obstetrics and Gynecology, Medical Informatics and Clinical Epidemiology, Public Health and Preventive Medicine, and Emergency Medicine, Oregon Health and Science University, Portland, OR, USA
| | - Neel Shah
- Beth Israel Deaconess Medical Center, Harvard T H Chan School of Public Health, Cambridge, MA, USA
| | - Kristina Gemzell-Danielsson
- Division of Obstetrics and Gynecology, Department of Women's and Children's Health, Karolinska Institute, Stockholm, Sweden
| | - K S Joseph
- Department of Obstetrics and Gynaecology, University of British Columbia, Vancouver, BC, Canada; School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada; The Children's and Women's Hospital of British Columbia, BC, Canada
| | - Barbara Levy
- George Washington University School of Medicine, Washington, DC, USA; Uniformed Services University of the Health Sciences, Washington, DC, USA
| | - Fontayne Wong
- Women's Health Research Institute, BC Women's Hospital and Health Centre, Vancouver, BC, Canada
| | - Susannah Woodd
- London School of Hygiene & Tropical Medicine, London, UK
| | - Elliott K Main
- California Maternal Quality Care Collaborative, San Francisco, CA, USA
| |
Collapse
|
22
|
Quality of basic maternal care functions in health facilities of five African countries: an analysis of national health system surveys. LANCET GLOBAL HEALTH 2016; 4:e845-e855. [DOI: 10.1016/s2214-109x(16)30180-2] [Citation(s) in RCA: 170] [Impact Index Per Article: 21.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/05/2016] [Revised: 06/23/2016] [Accepted: 07/20/2016] [Indexed: 01/22/2023]
|
23
|
Ananth CV, Lavery JA, Friedman AM, Wapner RJ, Wright JD. Serious maternal complications in relation to severe pre-eclampsia: a retrospective cohort study of the impact of hospital volume. BJOG 2016; 124:1246-1253. [PMID: 27770512 DOI: 10.1111/1471-0528.14384] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/07/2016] [Indexed: 11/26/2022]
Abstract
OBJECTIVE We examined rates of serious maternal complications in relation to severe pre-eclampsia based on the delivering hospital's annualised volume. DESIGN Retrospective cohort study. POPULATION AND SETTING Singleton deliveries (n = 25 782 235) in 439 hospitals in the USA. METHODS Annualised hospital volume was categorised as 25-500, 501-1000, 1001-2000 and >2000. MAIN OUTCOME MEASURES Rates of in-hospital maternal death and serious maternal complications, including puerperal cerebrovascular disorders, pulmonary oedema, disseminated intravascular coagulation, acute renal, heart and liver failure, sepsis, haemorrhage and intubation in relation to severe pre-eclampsia. We derived adjusted risk ratio (RR) and 95% confidence interval (CI), from hierarchical Poisson regression models. RESULTS Severe pre-eclampsia was associated with an 8.7-fold (95% CI 7.6, 10.1) risk of composite maternal complications, with similar RRs across levels of hospital volumes. However, compared with hospitals with low annual volume (<2000), maternal mortality rates in relation to severe pre-eclampsia were lower in high volume hospitals. The rates of serious maternal complications were 410.7 per 10 000 to women who delivered in hospitals with a high rate of severe pre-eclampsia (≥2.12%) and 584.8 per 10 000 to women who delivered in hospitals with low severe pre-eclampsia rates (≤0.41; RR 1.75, 95% CI 1.24, 2.45). CONCLUSIONS While the risks of serious maternal complications in relation to severe pre-eclampsia was similar across hospital delivery volume categories, deaths showed lower rates in large delivery volume hospitals than in smaller volume hospitals. The risk of complications was increased in hospitals with low compared with high severe pre-eclampsia rates. TWEETABLE ABSTRACT Hospital volume had little impact on the association between severe pre-eclampsia and maternal complications.
Collapse
Affiliation(s)
- C V Ananth
- Department of Obstetrics and Gynecology, College of Physicians and Surgeons, Columbia University, New York, NY, USA.,Department of Epidemiology, Joseph L. Mailman School of Public Health, Columbia University, New York, NY, USA
| | - J A Lavery
- Department of Obstetrics and Gynecology, College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - A M Friedman
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - R J Wapner
- Division of Maternal-Fetal Medicine, Department of Obstetrics and Gynecology, College of Physicians and Surgeons, Columbia University, New York, NY, USA
| | - J D Wright
- Division of Gynecologic Oncology, Department of Obstetrics and Gynecology, College of Physicians and Surgeons, Columbia University, New York, NY, USA
| |
Collapse
|
24
|
Kornelsen J, McCartney K, Williams K. Centralized or decentralized perinatal surgical care for rural women: a realist review of the evidence on safety. BMC Health Serv Res 2016; 16:381. [PMID: 27522230 PMCID: PMC4983412 DOI: 10.1186/s12913-016-1629-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2014] [Accepted: 08/04/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The precipitous closure of rural maternity services in British Columbia (BC), Canada, and internationally has demanded a reevaluation of how to meet the perinatal surgical needs of rural women in accordance with the Triple Aim objectives of safety, cost-effectiveness, and satisfaction of all key stakeholders. There is emerging international evidence that General Practitioners with Enhanced Surgical Skills (GPESS) are a well-positioned health service solution due to their generalist nature in low-volume settings. A realist review was undertaken to evaluate international evidence on efficacious models of perinatal surgical care. This article presents findings of the safety of such practice, one discrete part of the full realist review. METHODS This paper was derived from a larger review, which used a realist review methodology to guide the approach, and adhered to the RAMESES quality standard for realist reviews. Seven academic databases were searched in December 2013, using year (1990) and language (English) limiters in keeping with a rapid review approach. Mining of bibliographies in addition to consultation with international experts led to further inclusion of academic and grey literature up to March 2014. RESULTS Two hundred fifty-four articles were originally identified; 119 articles were removed from consideration for lack of fit, resulting in the review of 191 articles from the peer reviewed and grey literature. Of these, 53 pertained to safety and are considered herein. Evidence on the safety of GPESS was consistent in the literature cited. Clinical, case study, and qualitative evidence demonstrates that perinatal surgical care is equally safe when provided by GPESS and specialist physicians. CONCLUSION Findings allow health planners to confidently build perinatal surgical services around the contribution of GPs with enhanced surgical skills and focus on educational, regulatory, and continuing professional development mechanisms to ensure their sustainability. Volume-to-outcomes associations are variable and inconclusive with regards to safety, suggesting the need for more evidence. These findings, and the attendant health services planning directions, are reassuring as they suggest the viability of local models of care where feasible.
Collapse
Affiliation(s)
- Jude Kornelsen
- Department of Family Practice, University of British Columbia, David Strangway Building, 3rd Floor, 5950 University Blvd., Vancouver, V6T 1Z3 BC Canada
| | - Kevin McCartney
- Department of Family Practice, University of British Columbia, David Strangway Building, 3rd Floor, 5950 University Blvd., Vancouver, V6T 1Z3 BC Canada
| | - Kim Williams
- Perinatal Services BC, Provincial Health Services Authority, West Tower, Suite 350, West 12th Ave., Vancouver, V5Z 3X7 BC Canada
| |
Collapse
|
25
|
Scheerhagen M, van Stel HF, Tholhuijsen DJC, Birnie E, Franx A, Bonsel GJ. Applicability of the ReproQ client experiences questionnaire for quality improvement in maternity care. PeerJ 2016; 4:e2092. [PMID: 27478690 PMCID: PMC4950561 DOI: 10.7717/peerj.2092] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2016] [Accepted: 05/08/2016] [Indexed: 12/17/2022] Open
Abstract
Background. The ReproQuestionnaire (ReproQ) measures the client's experience with maternity care, following the WHO responsiveness model. In 2015, the ReproQ was appointed as national client experience questionnaire and will be added to the national list of indicators in maternity care. For using the ReproQ in quality improvement, the questionnaire should be able to identify best and worst practices. To achieve this, ReproQ should be reliable and able to identify relevant differences. Methods and Findings. We sent questionnaires to 17,867 women six weeks after labor (response 32%). Additionally, we invited 915 women for the retest (response 29%). Next we determined the test-retest reliability, the Minimally Important Difference (MID) and six known group comparisons, using two scorings methods: the percentage women with at least one negative experience and the mean score. The reliability for the percentage negative experience and mean score was both 'good' (Absolute agreement = 79%; intraclass correlation coefficient = 0.78). The MID was 11% for the percentage negative and 0.15 for the mean score. Application of the MIDs revealed relevant differences in women's experience with regard to professional continuity, setting continuity and having travel time. Conclusions. The measurement characteristics of the ReproQ support its use in quality improvement cycle. Test-retest reliability was good, and the observed minimal important difference allows for discrimination of good and poor performers, also at the level of specific features of performance.
Collapse
Affiliation(s)
- Marisja Scheerhagen
- Department of Obstetrics and Gynecology, Erasmus Medical Centre, Rotterdam, The Netherlands; Department of Obstetrics and Gynecology, Academic Collaborative Maternity Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Henk F van Stel
- Julius Center for Health Sciences and Primary Care, Department of Health Technology Assessment, University Medical Center Utrecht , Utrecht , The Netherlands
| | - Dominique J C Tholhuijsen
- Institute of Health Policy and Management, Erasmus University Rotterdam , Rotterdam , The Netherlands
| | - Erwin Birnie
- Department of Obstetrics and Gynecology, Academic Collaborative Maternity Care, University Medical Center Utrecht , Utrecht , The Netherlands
| | - Arie Franx
- Department of Obstetrics and Gynecology, University Medical Center Utrecht , Utrecht , The Netherlands
| | - Gouke J Bonsel
- Department of Obstetrics and Gynecology, Erasmus Medical Centre, Rotterdam, The Netherlands; Department of Obstetrics and Gynecology, Academic Collaborative Maternity Care, University Medical Center Utrecht, Utrecht, The Netherlands
| |
Collapse
|
26
|
Kornelsen J, Iglesias S, Woollard R. Rural Perinatal Surgical Services: Time for an Alliance Between Providers. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2016; 38:179-81. [PMID: 27032745 DOI: 10.1016/j.jogc.2015.12.017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2015] [Accepted: 09/13/2015] [Indexed: 11/29/2022]
Affiliation(s)
- Jude Kornelsen
- Department of Family Practice, University of British Columbia, Vancouver BC; Centre for Rural Health Research, Department of Family Practice, Vancouver BC
| | | | - Robert Woollard
- Department of Family Practice, University of British Columbia, Vancouver BC
| |
Collapse
|
27
|
Kildea S, McGhie AC, Gao Y, Rumbold A, Rolfe M. Babies born before arrival to hospital and maternity unit closures in Queensland and Australia. Women Birth 2015; 28:236-45. [DOI: 10.1016/j.wombi.2015.03.003] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2014] [Revised: 03/12/2015] [Accepted: 03/14/2015] [Indexed: 11/17/2022]
|
28
|
Hollowell J, Rowe R, Townend J, Knight M, Li Y, Linsell L, Redshaw M, Brocklehurst P, Macfarlane A, Marlow N, McCourt C, Newburn M, Sandall J, Silverton L. The Birthplace in England national prospective cohort study: further analyses to enhance policy and service delivery decision-making for planned place of birth. HEALTH SERVICES AND DELIVERY RESEARCH 2015. [DOI: 10.3310/hsdr03360] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BackgroundEvidence from the Birthplace in England Research Programme supported a policy of offering ‘low risk’ women a choice of birth setting, but a number of unanswered questions remained.AimsThis project aimed to provide further evidence to support the development and delivery of maternity services and inform women’s choice of birth setting: specifically, to explore maternal and organisational factors associated with intervention, transfer and other outcomes in each birth setting in ‘low risk’ and ‘higher risk’ women.DesignFive component studies using secondary analysis of the Birthplace prospective cohort study (studies 2–5) and ecological analysis of unit/NHS trust-level data (studies 1 and 5).SettingObstetric units (OUs), alongside midwifery units (AMUs), freestanding midwifery units (FMUs) and planned home births in England.ParticipantsStudies 1–4 focused on ‘low risk’ women with ‘term’ pregnancies planning vaginal birth in 43 AMUs (n = 16,573), in 53 FMUs (n = 11,210), at home in 147 NHS trusts (n = 16,632) and in a stratified, random sample of 36 OUs (n = 19,379) in 2008–10. Study 5 focused on women with pre-existing medical and obstetric risk factors (‘higher risk’ women).Main outcome measuresInterventions (instrumental delivery, intrapartum caesarean section), a measure of low intervention (‘normal birth’), a measure of spontaneous vaginal birth without complications (‘straightforward birth’), transfer during labour and a composite measure of adverse perinatal outcome (‘intrapartum-related mortality and morbidity’ or neonatal admission within 48 hours for > 48 hours). In studies 1 and 3, rates of intervention/maternal outcome and transfer were adjusted for maternal characteristics.AnalysisWe used (a) funnel plots to explore variation in rates of intervention/maternal outcome and transfer between units/trusts, (b) simple, weighted linear regression to evaluate associations between unit/trust characteristics and rates of intervention/maternal outcome and transfer, (c) multivariable Poisson regression to evaluate associations between planned place of birth, maternal characteristics and study outcomes, and (d) logistic regression to investigate associations between time of day/day of the week and study outcomes.ResultsStudy 1 – unit-/trust-level variations in rates of interventions, transfer and maternal outcomes were not explained by differences in maternal characteristics. The magnitude of identified associations between unit/trust characteristics and intervention, transfer and outcome rates was generally small, but some aspects of configuration were associated with rates of transfer and intervention. Study 2 – ‘low risk’ women planning non-OU birth had a reduced risk of intervention irrespective of ethnicity or area deprivation score. In nulliparous women planning non-OU birth the risk of intervention increased with increasing age, but women of all ages planning non-OU birth experienced a reduced risk of intervention. Study 3 – parity, maternal age, gestational age and ‘complicating conditions’ identified at the start of care in labour were independently associated with variation in the risk of transfer in ‘low risk’ women planning non-OU birth. Transfers did not vary by time of day/day of the week in any meaningful way. The duration of transfer from planned FMU and home births was around 50–60 minutes; transfers for ‘potentially urgent’ reasons were quicker than transfers for ‘non-urgent’ reasons. Study 4 – the occurrence of some interventions varied by time of the day/day of the week in ‘low risk’ women planning OU birth. Study 5 – ‘higher risk’ women planning birth in a non-OU setting had fewer risk factors than ‘higher risk’ women planning OU birth and these risk factors were different. Compared with ‘low risk’ women planning home birth, ‘higher risk’ women planning home birth had a significantly increased risk of our composite adverse perinatal outcome measure. However, in ‘higher risk’ women, the risk of this outcome was lower in planned home births than in planned OU births, even after adjustment for clinical risk factors.ConclusionsExpansion in the capacity of non-OU intrapartum care could reduce intervention rates in ‘low risk’ women, and the benefits of midwifery-led intrapartum care apply to all ‘low risk’ women irrespective of age, ethnicity or area deprivation score. Intervention rates differ considerably between units, however, for reasons that are not understood. The impact of major changes in the configuration of maternity care on outcomes should be monitored and evaluated. The impact of non-clinical factors, including labour ward practices, staffing and skill mix and women’s preferences and expectations, on intervention requires further investigation. All women planning non-OU birth should be informed of their chances of transfer and, in particular, older nulliparous women and those more than 1 week past their due date should be advised of their increased chances of transfer. No change in the guidance on planning place of birth for ‘higher risk’ women is recommended, but research is required to evaluate the safety of planned AMU birth for women with selected relatively common risk factors.FundingThe National Institute for Health Research Health Services and Delivery Research programme.
Collapse
Affiliation(s)
- Jennifer Hollowell
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Rachel Rowe
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - John Townend
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Marian Knight
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Yangmei Li
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Louise Linsell
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Maggie Redshaw
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | | | - Alison Macfarlane
- Centre for Maternal and Child Health Research, City University London, London, UK
| | - Neil Marlow
- Institute for Women’s Health, University College London, London, UK
| | - Christine McCourt
- Centre for Maternal and Child Health Research, City University London, London, UK
| | | | - Jane Sandall
- Division of Women’s Health, King’s College London, London, UK
| | | |
Collapse
|
29
|
Matos AR. The controversy over the restructuring of perinatal emergency services in Portugal and the importance of citizen participation in health care decision-making processes. HISTORIA, CIENCIAS, SAUDE--MANGUINHOS 2015; 22:705-722. [PMID: 26331640 DOI: 10.1590/s0104-59702015000300003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/01/2013] [Accepted: 02/02/2014] [Indexed: 06/05/2023]
Abstract
This article explores the controversial decision made by the Ministry of Health to restructure the perinatal emergency services in Portugal in 2006. Particular emphasis is given to the protests held across the country against, the actors involved, and the arguments put forward for and against the measure, in an attempt to understand the forms of knowledge and experiences brought to the discussion about the issues raised by the decision, and how different forms of knowledge are reconciled under a democratic process. In addition, this article explores the importance of citizen participation, including that which emerges from conflicting relations, in the formulation of health policies.
Collapse
Affiliation(s)
- Ana Raquel Matos
- Centro de Estudos Sociais, Universidade de Coimbra, Coimbra, PT,
| |
Collapse
|
30
|
Parazzini F, Cipriani S, Bulfoni G, Bulfoni C, Bellù R, Zanini R, Mosca F. Mode of delivery and level of neonatal care in Lombardy: a descriptive analysis according to volume of care. Ital J Pediatr 2015; 41:24. [PMID: 25888471 PMCID: PMC4477540 DOI: 10.1186/s13052-015-0129-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2014] [Accepted: 03/12/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Using data from the Hospital Discharge data-base (SDO) and from the Certificate of Delivery Assistance data-base (CedAP) we analysed mode of delivery and neonatal care in public and private hospitals in Lombardy Region during 2012. METHODS In Lombardy a standard form is used to register all discharges from public or private hospitals (the SDO data-base which contained information on inpatient activity provided to each patient by any hospital or clinic included in the Regional Health System. Further, information on maternal characteristics and pregnancy outcome are available for all deliveries in CedAP data-base. We obtained data regarding all deliveries (mother discharge data-base M-SDO)and newborns discharge (N-SDO) and the CedAP data-base over the period January-December 2012 by the Lombardy Health Directorate. After linkage (using an anonymous key) of the three data-base using anonymized codes we obtained a data-base by the linkage of CedAP and N-SDO records, which includes, after elimination of incorrect codes, information on 90863 neonates and a data-base obtained by the linkage of CedAP and M-SDO records, which includes information on 90868 mother and deliveries. Using these data-base we have analysed mode of delivery and neonatal care in Lombardy according to the volume of care (VoC = number of delivery per year in the care unit). RESULTS In 2012, in Lombardy, less than 3% of newborns were born in hospitals reporting less than 500 deliveries/year and less than 30% in hospitals reporting < 1000 deliveries per year. Cesarean section rate was higher in units reporting less than 1000 deliveries/year (28.7% versus 27.5% in hospitals with more than 1000 deliveries/year). In hospitals reporting 500, 500-799, 800-999 deliveries/year the percentage of preterm births with gestational age <33 weeks ranged from 0.1% to 0.2%, but was 3.4% in hospitals reporting 2500 deliveries per year or more. A total of 0.6% of newborns weighing less than 1000 grams and 3.2% of newborns with birth weight between 1000 and 1499 grams was born in hospitals which reported 1000 deliveries or more. CONCLUSIONS This article provides an overview of delivery and neonatal care in the Lombardy Region with a focus on volume of care.
Collapse
Affiliation(s)
- Fabio Parazzini
- Fondazione IRCCS Cà Granda, Dipartimento Materno-Infantile, Ospedale Maggiore Policlinico, Università degli Studi di Milano, Via Commenda 12, 20122, Milan, Italy. .,Dipartimento di Scienze Cliniche e di Comunità, Universita' di Milano, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Via Commenda 12, 20122, Milano, Italy.
| | - Sonia Cipriani
- Fondazione IRCCS Cà Granda, Dipartimento Materno-Infantile, Ospedale Maggiore Policlinico, Università degli Studi di Milano, Via Commenda 12, 20122, Milan, Italy.
| | - Giuseppe Bulfoni
- Fondazione IRCCS Cà Granda, Dipartimento Materno-Infantile, Ospedale Maggiore Policlinico, Università degli Studi di Milano, Via Commenda 12, 20122, Milan, Italy.
| | - Camilla Bulfoni
- Dipartimento Materno Infantile, Ospedale Buzzi, Università degli Studi di Milano, Via Castelvetro 32, 20154, Milano, Italy.
| | - Roberto Bellù
- NICU Azienda Ospedaliera della Provinciale di Lecco, Via dell'Eremo 9/11, 23900, Lecco, Italy.
| | - Rinaldo Zanini
- Dipartimento Materno-Infantile Azienda Provinciale Ospedaliera di Lecco, Milan, Italy.
| | - Fabio Mosca
- Fondazione IRCCS Cà Granda, Dipartimento Materno-Infantile, Ospedale Maggiore Policlinico, Università degli Studi di Milano, Via Commenda 12, 20122, Milan, Italy.
| |
Collapse
|
31
|
Kruske S, Schultz T, Eales S, Kildea S. A retrospective, descriptive study of maternal and neonatal transfers, and clinical outcomes of a Primary Maternity Unit in rural Queensland, 2009–2011. Women Birth 2015; 28:30-9. [DOI: 10.1016/j.wombi.2014.10.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2014] [Revised: 10/11/2014] [Accepted: 10/14/2014] [Indexed: 11/26/2022]
|
32
|
Snowden JM, Cheng YW, Emeis CL, Caughey AB. The impact of hospital obstetric volume on maternal outcomes in term, non-low-birthweight pregnancies. Am J Obstet Gynecol 2015; 212:380.e1-9. [PMID: 25263732 DOI: 10.1016/j.ajog.2014.09.026] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2014] [Revised: 08/05/2014] [Accepted: 09/23/2014] [Indexed: 10/24/2022]
Abstract
OBJECTIVE The impact of hospital obstetric volume specifically on maternal outcomes remains under studied. We examined the impact of hospital obstetric volume on maternal outcomes in low-risk women who delivered non-low-birthweight infants at term. STUDY DESIGN We conducted a retrospective cohort study of term singleton, non-low-birthweight live births from 2007-2008 in California. Deliveries were categorized by hospital obstetric volume categories and separately for nonrural hospitals (category 1: 50-1199 deliveries per year; category 2: 1200-2399; category 3: 2400-3599, and category 4: ≥3600) and rural hospitals (category R1: 50-599 births per year; category R2: 600-1699; category R3: ≥1700). Maternal outcomes were compared with the use of the chi-square test and multivariable logistic regression. RESULTS There were 736,643 births in 267 hospitals that met study criteria. After adjustment for confounders, there were higher rates of postpartum hemorrhage in the lowest-volume rural hospitals (category R1 adjusted odds ratio, 3.06; 95% confidence interval, 1.51-6.23). Rates of chorioamnionitis, endometritis, severe perineal lacerations, and wound infection did not differ between volume categories. Longer lengths of stay were observed after maternal complications (eg, chorioamnionitis) in the lowest-volume hospitals (16.9% prolonged length of stay in category 1 hospitals vs 10.5% in category 4 hospitals; adjusted odds ratio, 1.91; 95% confidence interval, 1.01-3.61). CONCLUSION After confounder adjustment, few maternal outcomes differed by hospital obstetric volume. However, elevated odds of postpartum hemorrhage in low-volume rural hospitals raises the possibility that maternal outcomes may differ by hospital volume and geography. Further research is needed on maternal outcomes in hospitals of different obstetric volumes.
Collapse
|
33
|
Escuriet-Peiró R, Goberna-Tricas J, Pueyo-Sanchez MJ, Garriga-Comas N, Úbeda-Bonet I, Caja-López C, Espiga-López I, Ortún-Rubio V. Impact of maternity care policy in Catalonia: a retrospective cross-sectional study of service delivery in public and private hospitals. BMC Pregnancy Childbirth 2015; 15:23. [PMID: 25881263 PMCID: PMC4337058 DOI: 10.1186/s12884-015-0446-y] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2014] [Accepted: 01/20/2015] [Indexed: 11/10/2022] Open
Abstract
Background As a result of the growing number of interventions that are now performed in the context of maternity care, health authorities have begun to examine the possible repercussions for service provision and for maternal and neonatal health. In Spain the Strategy Paper on Normal Childbirth was published in 2008, and since then the authorities in Catalonia have sought to implement its recommendations. This paper reviews the current provision of maternity care in Catalonia. Methods This was a descriptive study. Hospitals were grouped according to their source of funding (public or private) and were stratified (across four strata) on the basis of the annual number of births recorded within their respective maternity service. Data regarding the distribution of obstetric professionals were taken from an official government survey of hospitals published in 2010. The data on obstetric interventions (caesarean, use of forceps, vacuum or non-specified instruments) performed in 2007, 2010 and 2012 were obtained by consulting discharge records of 44 public and 20 private hospitals, which together provide care in 98% of all births in Catalonia. Proportions and confidence intervals were calculated for each intervention performed in all full-term (37–42 weeks) singleton births. Results Analysis of staff profiles according to the stratification of hospitals showed that almost all the hospitals had more obstetricians than midwives among their maternity care staff. Public hospitals performed fewer caesareans [range between 19.20% (CI 18.84-19.55) and 28.14% (CI 27.73-28.54)] than did private hospitals [range between 32.21% (CI 31.78-32.63) and 39.43% (CI 38.98-39.87)]. The use of forceps has decreased in public hospitals. The use of a vacuum extractor has increased and is more common in private hospitals. Conclusions Caesarean section is the most common obstetric intervention performed during full-term singleton births in Catalonia. The observed trend is stable in the group of public hospitals, but shows signs of a rise among private institutions. The number of caesareans performed in accredited public hospitals covers a limited range with a stable trend. Among public hospitals the highest rate of caesareans is found in non-accredited hospitals with a lower annual number of births.
Collapse
Affiliation(s)
- Ramón Escuriet-Peiró
- Department of Experimental and Health Sciences, Universitat Pompeu Fabra (UPF), Barcelona, Spain. .,Directorate-General for Health Planning and Research, Ministry of Health of the Government of Catalonia, Barcelona, Spain.
| | - Josefina Goberna-Tricas
- Department of Public Health, Mental Health and Perinatal Nursing, Universitat de Barcelona, Bellvitge Health Sciences Campus, Pavelló de Govern, 3a planta, C/Feixa Llarga s/n, 08907, L'Hospitalet de Llobregat, Barcelona, Spain.
| | - Maria J Pueyo-Sanchez
- Directorate-General for Health Planning and Research, Ministry of Health of the Government of Catalonia, Barcelona, Spain.
| | - Neus Garriga-Comas
- Department of Public Health, Mental Health and Perinatal Nursing, Universitat de Barcelona, Bellvitge Health Sciences Campus, Pavelló de Govern, 3a planta, C/Feixa Llarga s/n, 08907, L'Hospitalet de Llobregat, Barcelona, Spain. .,Hospital de Manresa, Fundació Althaia, Manresa, Spain.
| | - Immaculada Úbeda-Bonet
- Department of Public Health, Mental Health and Perinatal Nursing, Universitat de Barcelona, Bellvitge Health Sciences Campus, Pavelló de Govern, 3a planta, C/Feixa Llarga s/n, 08907, L'Hospitalet de Llobregat, Barcelona, Spain.
| | - Carmen Caja-López
- Department of Public Health, Mental Health and Perinatal Nursing, Universitat de Barcelona, Bellvitge Health Sciences Campus, Pavelló de Govern, 3a planta, C/Feixa Llarga s/n, 08907, L'Hospitalet de Llobregat, Barcelona, Spain.
| | - Isabel Espiga-López
- Observatory on Women's Health, Subdirectorate for Quality and Cohesion, Ministry of Health, Social Services and Equality, Madrid, Spain.
| | - Vicente Ortún-Rubio
- Faculty of Economic and Business Sciences, Universitat Pompeu Fabra (UPF), Barcelona, Spain.
| |
Collapse
|
34
|
Campbell AM, Brown J, Simon DR, Young S, Kinsman L. Leading the rebirth of the rural obstetrician. Med J Aust 2014; 201:667-70. [PMID: 25495313 DOI: 10.5694/mja14.00278] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2014] [Accepted: 09/29/2014] [Indexed: 11/17/2022]
Affiliation(s)
- Alison M Campbell
- School of Rural Health, Monash University, Bendigo, VIC
- Palliative and Supportive Services, Flinders University, Adelaide, VIC
| | - James Brown
- General Practice, Southern General Practice Training, Churchill, VIC
| | | | - Sari Young
- School of Rural Health, Monash University, Bendigo, VIC
| | - Leigh Kinsman
- School of Rural Health, Monash University, Bendigo, VIC
| |
Collapse
|
35
|
Effect of patient risk on the volume–outcome relationship in obstetric delivery services. Health Policy 2014; 118:407-12. [DOI: 10.1016/j.healthpol.2014.05.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2013] [Revised: 05/12/2014] [Accepted: 05/30/2014] [Indexed: 11/22/2022]
|
36
|
Monk A, Tracy M, Foureur M, Grigg C, Tracy S. Evaluating Midwifery Units (EMU): a prospective cohort study of freestanding midwifery units in New South Wales, Australia. BMJ Open 2014; 4:e006252. [PMID: 25361840 PMCID: PMC4216868 DOI: 10.1136/bmjopen-2014-006252] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVE To compare maternal and neonatal birth outcomes and morbidities associated with the intention to give birth in two freestanding midwifery units and two tertiary-level maternity units in New South Wales, Australia. DESIGN Prospective cohort study. PARTICIPANTS 494 women who intended to give birth at freestanding midwifery units and 3157 women who intended to give birth at tertiary-level maternity units. Participants had low risk, singleton pregnancies and were at less than 28(+0) weeks gestation at the time of booking. PRIMARY AND SECONDARY OUTCOME MEASURES Primary outcomes were mode of birth, Apgar score of less than 7 at 5 min and admission to the neonatal intensive care unit or special care nursery. Secondary outcomes were onset of labour, analgesia, blood loss, management of third stage of labour, perineal trauma, transfer, neonatal resuscitation, breastfeeding, gestational age at birth, birth weight, severe morbidity and mortality. RESULTS Women who planned to give birth at a freestanding midwifery unit were significantly more likely to have a spontaneous vaginal birth (AOR 1.57; 95% CI 1.20 to 2.06) and significantly less likely to have a caesarean section (AOR 0.65; 95% CI 0.48 to 0.88). There was no significant difference in the AOR of 5 min Apgar scores, however, babies from the freestanding midwifery unit group were significantly less likely to be admitted to neonatal intensive care or special care nursery (AOR 0.60; 95% CI 0.39 to 0.91). Analysis of secondary outcomes indicated that planning to give birth in a freestanding midwifery unit was associated with similar or reduced odds of intrapartum interventions and similar or improved odds of indicators of neonatal well-being. CONCLUSIONS The results of this study support the provision of care in freestanding midwifery units as an alternative to tertiary-level maternity units for women with low risk pregnancies at the time of booking.
Collapse
Affiliation(s)
- Amy Monk
- Faculty of Nursing and Midwifery, The University of Sydney, Sydney, New South Wales, Australia
| | - Mark Tracy
- Centre for Newborn Care, Westmead Hospital and The University of Sydney, Sydney, New South Wales, Australia
| | - Maralyn Foureur
- Centre for Midwifery, Child and Family Health, Faculty of Health, The University of Technology Sydney, Sydney, Australia
| | - Celia Grigg
- Faculty of Nursing and Midwifery, The University of Sydney, Sydney, New South Wales, Australia
| | - Sally Tracy
- Centre for Midwifery & Women's Health Nursing Research Unit, The Royal Hospital for Women and the University of Sydney, Sydney, Australia
| |
Collapse
|
37
|
Hoang H, Le Q, Ogden K. Women's maternity care needs and related service models in rural areas: A comprehensive systematic review of qualitative evidence. Women Birth 2014; 27:233-41. [PMID: 25028188 DOI: 10.1016/j.wombi.2014.06.005] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2014] [Revised: 05/30/2014] [Accepted: 06/19/2014] [Indexed: 11/30/2022]
Abstract
BACKGROUND Understanding the needs of rural women in maternity care and service models available to them is significant for the development of effective policies and the sustainability of rural communities. Nevertheless, no systematic review of studies addressing these needs has been conducted. OBJECTIVES To synthesise the best available evidence on the experiences of women's needs in maternity care and existing service models in rural areas. METHODS Literature search of ten electronic databases, digital theses, and reference lists of relevant studies applying inclusion/exclusion criteria was conducted. Selected papers were assessed using standardised critical appraisal instruments from JBI-QARI. Data extracted from these studies were synthesised using thematic synthesis. FINDINGS 12 studies met the inclusion criteria. There were three main themes and several sub-themes identified. A comprehensive set of the maternity care expectations of rural women was reported in this review including safety (7), continuity of care (6) and quality of care (6), and informed choices needs (4). In addition, challenges in accessing maternity services also emerged from the literature such as access (6), risk of travelling (9) and associated cost of travel (9). Four models of maternity care examined in the literature were medically led care (5), GP-led care (4), midwifery-led care (7) and home birth (6). CONCLUSION The systematic review demonstrates the importance of including well-conducted qualitative studies in informing the development of evidence-based policies to address women's maternity care needs and inform service models. Synthesising the findings from qualitative studies offers important insight for informing effective public health policy.
Collapse
Affiliation(s)
- Ha Hoang
- Centre for Rural Health, University of Tasmania, Locked Bag 1372, Launceston, Tasmania 7250, Australia.
| | - Quynh Le
- Centre for Rural Health, University of Tasmania, Locked Bag 1372, Launceston, Tasmania 7250, Australia.
| | - Kathryn Ogden
- School of Medicine, University of Tasmania, Locked Bag 1377, Launceston, Tasmania 7250, Australia.
| |
Collapse
|
38
|
Homer CSE, Thornton C, Scarf VL, Ellwood DA, Oats JJN, Foureur MJ, Sibbritt D, McLachlan HL, Forster DA, Dahlen HG. Birthplace in New South Wales, Australia: an analysis of perinatal outcomes using routinely collected data. BMC Pregnancy Childbirth 2014; 14:206. [PMID: 24929250 PMCID: PMC4067683 DOI: 10.1186/1471-2393-14-206] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2014] [Accepted: 06/11/2014] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND The outcomes for women who give birth in hospital compared with at home are the subject of ongoing debate. We aimed to determine whether a retrospective linked data study using routinely collected data was a viable means to compare perinatal and maternal outcomes and interventions in labour by planned place of birth at the onset of labour in one Australian state. METHODS A population-based cohort study was undertaken using routinely collected linked data from the New South Wales Perinatal Data Collection, Admitted Patient Data Collection, Register of Congenital Conditions, Registry of Birth Deaths and Marriages and the Australian Bureau of Statistics. Eight years of data provided a sample size of 258,161 full-term women and their infants. The primary outcome was a composite outcome of neonatal mortality and morbidity as used in the Birthplace in England study. RESULTS Women who planned to give birth in a birth centre or at home were significantly more likely to have a normal labour and birth compared with women in the labour ward group. There were no statistically significant differences in stillbirth and early neonatal deaths between the three groups, although we had insufficient statistical power to test reliably for these differences. CONCLUSION This study provides information to assist the development and evaluation of different places of birth across Australia. It is feasible to examine perinatal and maternal outcomes by planned place of birth using routinely collected linked data, although very large data sets will be required to measure rare outcomes associated with place of birth in a low risk population, especially in countries like Australia where homebirth rates are low.
Collapse
Affiliation(s)
- Caroline SE Homer
- Centre for Midwifery, Child and Family Health, Faculty of Health Level 7, University of Technology, 235-253 Jones St. Broadway, Sydney, New South Wales, Australia
| | | | - Vanessa L Scarf
- Centre for Midwifery, Child and Family Health, Faculty of Health Level 7, University of Technology, 235-253 Jones St. Broadway, Sydney, New South Wales, Australia
| | - David A Ellwood
- School of Medicine, Griffith University, Gold Coast, Queensland, Australia
| | - Jeremy JN Oats
- Consultative Council on Obstetric and Paediatric Mortality and Morbidity, Melbourne, Victoria, Australia
| | - Maralyn J Foureur
- Centre for Midwifery, Child and Family Health, Faculty of Health Level 7, University of Technology, 235-253 Jones St. Broadway, Sydney, New South Wales, Australia
| | - David Sibbritt
- Centre for Midwifery, Child and Family Health, Faculty of Health Level 7, University of Technology, 235-253 Jones St. Broadway, Sydney, New South Wales, Australia
| | - Helen L McLachlan
- Faculty of Health Sciences, La Trobe University, Melbourne, Australia
| | - Della A Forster
- Mother and Child Health Research Centre, La Trobe University and the Royal Women’s Hospital, Melbourne, Australia
| | - Hannah G Dahlen
- School of Nursing and Midwifery, University of Western Sydney, Sydney, Australia
| |
Collapse
|
39
|
Rowe RE, Townend J, Brocklehurst P, Knight M, Macfarlane A, McCourt C, Newburn M, Redshaw M, Sandall J, Silverton L, Hollowell J. Service configuration, unit characteristics and variation in intervention rates in a national sample of obstetric units in England: an exploratory analysis. BMJ Open 2014; 4:e005551. [PMID: 24875492 PMCID: PMC4039829 DOI: 10.1136/bmjopen-2014-005551] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/24/2014] [Accepted: 05/03/2014] [Indexed: 11/20/2022] Open
Abstract
OBJECTIVES To explore whether service configuration and obstetric unit (OU) characteristics explain variation in OU intervention rates in 'low-risk' women. DESIGN Ecological study using funnel plots to explore unit-level variations in adjusted intervention rates and simple linear regression, stratified by parity, to investigate possible associations between unit characteristics/configuration and adjusted intervention rates in planned OU births. Characteristics considered: OU size, presence of an alongside midwifery unit (AMU), proportion of births in the National Health Service (NHS) trust planned in midwifery units or at home and midwifery 'under' staffing. SETTING 36 OUs in England. PARTICIPANTS 'Low-risk' women with a 'term' pregnancy planning vaginal birth in a stratified, random sample of 36 OUs. MAIN OUTCOME MEASURES Adjusted rates of intrapartum caesarean section, instrumental delivery and two composite measures capturing birth without intervention ('straightforward' and 'normal' birth). RESULTS Funnel plots showed unexplained variation in adjusted intervention rates. In NHS trusts where proportionately more non-OU births were planned, adjusted intrapartum caesarean section rates in the planned OU births were significantly higher (nulliparous: R(2)=31.8%, coefficient=0.31, p=0.02; multiparous: R(2)=43.2%, coefficient=0.23, p=0.01), and for multiparous women, rates of 'straightforward' (R(2)=26.3%, coefficient=-0.22, p=0.01) and 'normal' birth (R(2)=17.5%, coefficient=0.24, p=0.01) were lower. The size of the OU (number of births), midwifery 'under' staffing levels (the proportion of shifts where there were more women than midwives) and the presence of an AMU were associated with significant variation in some interventions. CONCLUSIONS Trusts with greater provision of non-OU intrapartum care may have higher intervention rates in planned 'low-risk' OU births, but at a trust level this is likely to be more than offset by lower intervention rates in planned non-OU births. Further research using high quality data on unit characteristics and outcomes in a larger sample of OUs and trusts is required.
Collapse
Affiliation(s)
- Rachel E Rowe
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - John Townend
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Peter Brocklehurst
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
- Institute for Women's Health, University College London, London, UK
| | - Marian Knight
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Alison Macfarlane
- Centre for Maternal and Child Health Research, City University London, London, UK
| | - Christine McCourt
- Centre for Maternal and Child Health Research, City University London, London, UK
| | | | - Maggie Redshaw
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | - Jane Sandall
- Division of Women's Health, King's College London, London, UK
| | | | - Jennifer Hollowell
- National Perinatal Epidemiology Unit, Nuffield Department of Population Health, University of Oxford, Oxford, UK
| |
Collapse
|
40
|
Escuriet R, Pueyo M, Biescas H, Colls C, Espiga I, White J, Espada X, Fusté J, Ortún V. Obstetric interventions in two groups of hospitals in Catalonia: a cross-sectional study. BMC Pregnancy Childbirth 2014; 14:143. [PMID: 24731410 PMCID: PMC3990023 DOI: 10.1186/1471-2393-14-143] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2013] [Accepted: 04/03/2014] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Childbirth assistance in highly technological settings and existing variability in the interventions performed are cause for concern. In recent years, numerous recommendations have been made concerning the importance of the physiological process during birth. In Spain and Catalonia, work has been carried out to implement evidence-based practices for childbirth and to reduce unnecessary interventions.To identify obstetric intervention rates among all births, determine whether there are differences in interventions among full-term single births taking place in different hospitals according to type of funding and volume of births attended to, and to ascertain whether there is an association between caesarean section or instrumental birth rates and type of funding, the volume of births attended to and women's age. METHODS Cross-sectional study, taking the hospital as the unit of analysis, obstetric interventions as dependent variables, and type of funding, volume of births attended to and maternal age as explanatory variables. The analysis was performed in three phases considering all births reported in the MBDS Catalonia 2011 (7,8570 births), full-term single births and births coded as normal. RESULTS The overall caesarean section rate in Catalonia is 27.55% (CI 27.23 to 27.86). There is a significant difference in caesarean section rates between public and private hospitals in all strata. Both public and private hospitals with a lower volume of births have higher obstetric intervention rates than other hospitals (49.43%, CI 48.04 to 50.81). CONCLUSIONS In hospitals in Catalonia, both the type of funding and volume of births attended to have a significant effect on the incidence of caesarean section, and type of funding is associated with the use of instruments during delivery.
Collapse
Affiliation(s)
- Ramón Escuriet
- Directorate-General for Health Planning and Research, Ministry of Health of the Government of Catalonia, Pompeu Fabra University, Travessera de les Corts, 131-159, Pavelló Ave Maria, Barcelona, 08028, Spain
| | - María Pueyo
- Directorate-General for Health Planning and Research, Ministry of Health of the Government of Catalonia, Barcelona, Spain
| | - Herminia Biescas
- Directorate-General for Health Planning and Research, Ministry of Health of the Government of Catalonia, Barcelona, Spain
| | - Cristina Colls
- Catalan Agency for Health Information, Assessment and Quality, Barcelona, Spain
| | - Isabel Espiga
- Observatory on Women’s Health, Subdirectorate for Quality and Cohesion, Ministry of Health, Social Services and Equality, Madrid, Spain
| | - Joanna White
- Centre for Research in Anthropology (CRIA-IUL), Lisbon, Portugal
- Visiting Fellow, King’s College London, London, UK
| | - Xavi Espada
- Fundació Hospital Asil de Granollers, Granollers, Spain
| | - Josep Fusté
- Directorate-General for Health Planning and Research, Ministry of Health of the Government of Catalonia, Barcelona, Spain
| | - Vicente Ortún
- Faculty of Economic and Business Sciences, Pompeu Fabra University, Barcelona, Spain
| |
Collapse
|
41
|
Poeran J, Borsboom GJJM, de Graaf JP, Birnie E, Steegers EAP, Mackenbach JP, Bonsel GJ. Does centralisation of acute obstetric care reduce intrapartum and first-week mortality? An empirical study of over 1 million births in the Netherlands. Health Policy 2014; 117:28-38. [PMID: 24703856 DOI: 10.1016/j.healthpol.2014.03.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2013] [Revised: 03/13/2014] [Accepted: 03/15/2014] [Indexed: 10/25/2022]
Abstract
In this hypothetical analysis with retrospective cohort data (1,160,708 hospital births) we estimated outcome of centralisation of acute obstetric care, i.e., closure of 10 hospitals (out of 99) in The Netherlands. The main outcome was predicted intrapartum and first-week mortality (further referred to as neonatal mortality) for several subgroups of patients affected by two centralisation scenarios: (1) closure of the 10 smallest hospitals; (2) closure of the 10 smallest hospitals, but avoiding adjacent closures. Predictions followed from regression coefficients from a multilevel logistic regression model. Scenario 1 resulted in doubled travel time, and 10% increased mortality (210 [0.34%] to 231 [0.38%] cases). Scenario 2 showed less effect on mortality (268 [0.33%] to 259 [0.32%] cases) and travel time. Heterogeneity in hospital organisational features caused simultaneous improvement and deterioration of predicted neonatal mortality. Consequences vary for subgroups. We demonstrate that (in The Netherlands) centralisation of acute obstetric care according to the 'closure-of-the-smallest-rule' yields suboptimal outcomes. In order to develop an optimal strategy one would need to consider all positive and negative effects, e.g., organisational heterogeneity of closing and surviving hospitals, differential effects for patient subgroups, increased travel time, and financial aspects. The provided framework may be beneficial for other countries considering centralisation of acute obstetric care.
Collapse
Affiliation(s)
- Jashvant Poeran
- Department of Obstetrics and Gynaecology, Division of Obstetrics & Prenatal Medicine, Erasmus MC, PO Box 2040, 3000 CA Rotterdam, The Netherlands.
| | - Gerard J J M Borsboom
- Department of Public Health, Erasmus MC, PO Box 2040, 3000 CA Rotterdam, The Netherlands.
| | - Johanna P de Graaf
- Department of Obstetrics and Gynaecology, Division of Obstetrics & Prenatal Medicine, Erasmus MC, PO Box 2040, 3000 CA Rotterdam, The Netherlands.
| | - Erwin Birnie
- Department of Obstetrics and Gynaecology, Division of Obstetrics & Prenatal Medicine, Erasmus MC, PO Box 2040, 3000 CA Rotterdam, The Netherlands; Institute of Health Policy and Management, Erasmus University Rotterdam, PO Box 1738, 3000 DR Rotterdam, The Netherlands.
| | - Eric A P Steegers
- Department of Obstetrics and Gynaecology, Division of Obstetrics & Prenatal Medicine, Erasmus MC, PO Box 2040, 3000 CA Rotterdam, The Netherlands.
| | - Johan P Mackenbach
- Department of Public Health, Erasmus MC, PO Box 2040, 3000 CA Rotterdam, The Netherlands.
| | - Gouke J Bonsel
- Department of Obstetrics and Gynaecology, Division of Obstetrics & Prenatal Medicine, Erasmus MC, PO Box 2040, 3000 CA Rotterdam, The Netherlands; Department of Public Health, Erasmus MC, PO Box 2040, 3000 CA Rotterdam, The Netherlands; Rotterdam Midwifery Academy, 'Rochussenstraat building', PO Box 2040, 3000 CA Rotterdam, The Netherlands.
| |
Collapse
|
42
|
Hoang H, Le Q, Terry D. Women's access needs in maternity care in rural Tasmania, Australia: A mixed methods study. Women Birth 2014; 27:9-14. [DOI: 10.1016/j.wombi.2013.02.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2012] [Revised: 01/18/2013] [Accepted: 02/07/2013] [Indexed: 11/25/2022]
|
43
|
Grytten J, Monkerud L, Skau I, Sørensen R. Regionalization and local hospital closure in Norwegian maternity care--the effect on neonatal and infant mortality. Health Serv Res 2014; 49:1184-204. [PMID: 24476021 DOI: 10.1111/1475-6773.12153] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE To study whether neonatal and infant mortality, after adjustments for differences in case mix, were independent of the type of hospital in which the delivery was carried out. DATA The Medical Birth Registry of Norway provided detailed medical information for all births in Norway. STUDY DESIGN Hospitals were classified into two groups: local hospitals/maternity clinics versus central/regional hospitals. Outcomes were neonatal and infant mortality. The data were analyzed using propensity score weighting to make adjustments for differences in case mix between the two groups of hospitals. This analysis was supplemented with analyses of 13 local hospitals that were closed. Using a difference-in-difference approach, the effects that these closures had on neonatal and infant mortality were estimated. PRINCIPAL FINDING Neonatal and infant mortality were not affected by the type of hospital where the delivery took place. CONCLUSION A regionalized maternity service does not lead to increased neonatal and infant mortality. This is mainly because high-risk deliveries were identified well in advance of the birth, and referred to a larger hospital with sufficient perinatal resources to deal with these deliveries.
Collapse
Affiliation(s)
- Jostein Grytten
- Department of Obstetrics and Gynecology, Institute of Clinical Medicine, Akershus University Hospital, Lørenskog, Norway
| | | | | | | |
Collapse
|
44
|
Engjom HM, Morken N, Norheim OF, Klungsøyr K. Availability and access in modern obstetric care: a retrospective population‐based study. BJOG 2013; 121:290-9. [DOI: 10.1111/1471-0528.12510] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/01/2013] [Indexed: 11/28/2022]
Affiliation(s)
- HM Engjom
- Department of Global Public Health and Primary Care University of Bergen Bergen Norway
| | - N‐H Morken
- Department of Global Public Health and Primary Care University of Bergen Bergen Norway
- Department of Obstetrics and Gynecology Haukeland University Hospital Bergen Norway
| | - OF Norheim
- Department of Global Public Health and Primary Care University of Bergen Bergen Norway
- Department of Research and Development Haukeland University Hospital Bergen Norway
| | - K Klungsøyr
- Department of Global Public Health and Primary Care University of Bergen Bergen Norway
- Medical Birth Registry of Norway Norwegian Institute of Public Health Bergen Norway
| |
Collapse
|
45
|
Biro MA, Knight M, Wallace E, Papacostas K, East C. Is place of birth associated with mode of birth? The effect of hospital on caesarean section rates in a public metropolitan health service. Aust N Z J Obstet Gynaecol 2013; 54:64-70. [DOI: 10.1111/ajo.12147] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2013] [Accepted: 09/18/2013] [Indexed: 11/30/2022]
Affiliation(s)
- Mary A. Biro
- School of Nursing and Midwifery; Monash University; Clayton Victoria Australia
| | - Michelle Knight
- Women's Health Information Team; Women's and Children's Program; Monash Health; Monash Medical Centre; Clayton Victoria Australia
| | - Euan Wallace
- The Ritchie Centre; Monash Institute of Medical Research; Clayton Victoria Australia
- Department of Obstetrics and Gynaecology; Monash Health; Monash Medical Centre; Monash University; Clayton Victoria Australia
| | - Kerrie Papacostas
- Women's and Children's Program; Monash Health; Monash Medical Centre; Clayton Victoria Australia
| | - Christine East
- Monash Medical Centre; Monash University/Monash Health; Clayton Victoria Australia
| |
Collapse
|
46
|
Catling-Paull C, Coddington RL, Foureur MJ, Homer CSE. Publicly funded homebirth in Australia: a review of maternal and neonatal outcomes over 6 years. Med J Aust 2013; 198:616-20. [PMID: 23919710 DOI: 10.5694/mja12.11665] [Citation(s) in RCA: 43] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2012] [Accepted: 04/26/2013] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To report maternal and neonatal outcomes for Australian women planning a publicly funded homebirth from 2005 to 2010. DESIGN, SETTING AND SUBJECTS Retrospective analysis of data on women who planned a homebirth and on their babies. Data for 2005-2010 (or from the commencement of a program to 2010) were requested from the 12 publicly funded homebirth programs in place at the time. MAIN OUTCOME MEASURES Maternal outcomes (mortality; place and mode of birth; perineal trauma; type of management of the third stage of labour; postpartum haemorrhage; transfer to hospital); and neonatal outcomes (early mortality; Apgar score at 5 minutes; birthweight; breastfeeding initially and at 6 weeks; significant morbidity; transfer to hospital; admission to a special care nursery). RESULTS Nine publicly funded homebirth programs in Australia provided data accounting for 97% of births in these programs during the period studied. Of the 1807 women who intended to give birth at home at the onset of labour, 1521 (84%) did so. 315 (17%) were transferred to hospital during labour or within one week of giving birth. The rate of stillbirth and early neonatal death was 3.3 per 1000 births; when deaths because of expected fetal anomalies were excluded it was 1.7 per 1000 births. The rate of normal vaginal birth was 90%. CONCLUSION This study provides the first national evaluation of a significant proportion of women choosing publicly funded homebirth in Australia; however, the sample size does not have sufficient power to draw a conclusion about safety. More research is warranted into the safety of alternative places of birth within Australia.
Collapse
Affiliation(s)
- Christine Catling-Paull
- Centre for Midwifery, Child and Family Health, Faculty of Health, University of Technology Sydney, Sydney, NSW, Australia.
| | | | | | | | | | | |
Collapse
|
47
|
Combier E, Charreire H, Le Vaillant M, Michaut F, Ferdynus C, Amat-Roze JM, Gouyon JB, Quantin C, Zeitlin J. Perinatal health inequalities and accessibility of maternity services in a rural French region: closing maternity units in Burgundy. Health Place 2013; 24:225-33. [PMID: 24177417 DOI: 10.1016/j.healthplace.2013.09.006] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2013] [Revised: 06/01/2013] [Accepted: 09/18/2013] [Indexed: 11/19/2022]
Abstract
Maternity unit closures in France have increased travel time for pregnant women in rural areas. We assessed the impact of travel time to the closest unit on perinatal outcomes and care in Burgundy using multilevel analyses of data on deliveries from 2000 to 2009. A travel time of 30min or more increased risks of fetal heart rate anomalies, meconium-stained amniotic fluid, out-of-hospital births, and pregnancy hospitalizations; a positive but non-significant gradient existed between travel time and perinatal mortality. The effects of long travel distances on perinatal outcomes and care should be factored into closure decisions.
Collapse
Affiliation(s)
- Evelyne Combier
- Centre d'épidémiologie et de santé publique Bourgogne (EA4184). Faculté de Médecine, Dijon, France.
| | | | | | | | | | | | | | | | | |
Collapse
|
48
|
|
49
|
Australian primary maternity units: Past, present and future. Women Birth 2013; 26:213-8. [DOI: 10.1016/j.wombi.2013.06.001] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2012] [Revised: 06/05/2013] [Accepted: 06/05/2013] [Indexed: 11/21/2022]
|
50
|
Snowden JM, Cheng YW, Kontgis CP, Caughey AB. The association between hospital obstetric volume and perinatal outcomes in California. Am J Obstet Gynecol 2012; 207:478.e1-7. [PMID: 23174387 DOI: 10.1016/j.ajog.2012.09.029] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2012] [Revised: 09/10/2012] [Accepted: 09/26/2012] [Indexed: 10/27/2022]
Abstract
OBJECTIVE We sought to analyze the association between hospital obstetric volume and perinatal outcomes in California. STUDY DESIGN This was a retrospective cohort study of births occurring in California in 2006. Hospitals were divided into 4 obstetric volume categories. Unadjusted rates of neonatal mortality and birth asphyxia were calculated for each category, overall and among term deliveries with birthweight >2500 g. Multivariable logistic regression was used to control for confounders. Deliveries in rural hospitals were analyzed separately using different volume categories. RESULTS Prevalence of asphyxia increased with decreasing hospital volume overall and among term, non-low-birthweight infants, from 9/10,000 live births at highest-volume hospitals to 18/10,000 live births at the lowest-volume hospitals (P < .001). Similar trends were observed in rural hospitals, with rates increasing from 7-34/10,000 live births in low-volume rural hospitals (P < .001). CONCLUSION These findings provide evidence for an inverse association between hospital obstetric volume and birth asphyxia.
Collapse
|