1
|
Olsen O, Clausen JA. Planned hospital birth compared with planned home birth for pregnant women at low risk of complications. Cochrane Database Syst Rev 2023; 3:CD000352. [PMID: 36884026 PMCID: PMC9994459 DOI: 10.1002/14651858.cd000352.pub3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/09/2023]
Abstract
BACKGROUND Observational studies of increasingly better quality and in different settings suggest that planned hospital birth in many places does not reduce mortality and morbidity but increases the frequency of interventions and complications. Euro-Peristat (part of the European Union's Health Monitoring Programme) has raised concerns about iatrogenic effects of obstetric interventions, and the World Health Organization (WHO) has raised concern that the increasing medicalisation of childbirth tends to undermine women's own capability to give birth and negatively impacts their childbirth experience. This is an update of a Cochrane Review first published in 1998, and previously updated in 2012. OBJECTIVES To compare the effects of planned hospital birth with planned home birth attended by a midwife or others with midwifery skills and backed up by a modern hospital system in case a transfer to hospital should turn out to be necessary. The primary focus is on women with an uncomplicated pregnancy and low risk of medical intervention during birth. SEARCH METHODS: For this update, we searched Cochrane Pregnancy and Childbirth's Trials Register (which includes trials from CENTRAL, MEDLINE, Embase, CINAHL, WHO ICTRP, and conference proceedings), ClinicalTrials.gov (16 July 2021), and reference lists of retrieved studies. SELECTION CRITERIA Randomised controlled trials (RCTs) comparing planned hospital birth with planned home birth in low-risk women as described in the objectives. Cluster-randomised trials, quasi-randomised trials, and trials published only as an abstract were also eligible. DATA COLLECTION AND ANALYSIS Two review authors independently assessed trials for inclusion and risk of bias, extracted data, and checked the data for accuracy. We contacted study authors for additional information. We assessed the certainty of the evidence using the GRADE approach. MAIN RESULTS: We included one trial involving 11 participants. This was a small feasibility study to show that well-informed women - contrary to common beliefs - were prepared to be randomised. This update did not identify any additional studies for inclusion, but excluded one study that had been awaiting assessment. The included study was at high risk of bias for three out of seven risk of bias domains. The trial did not report on five of the seven primary outcomes, and reported zero events for one primary outcome (caesarean section), and non-zero events for the remaining primary outcome (baby not breastfed). Maternal mortality, perinatal mortality (non-malformed), Apgar < 7 at 5 minutes, transfer to neonatal intensive care unit, and maternal satisfaction were not reported. The overall certainty of the evidence for the two reported primary outcomes was very low according to our GRADE assessment (downgraded two levels for high overall risk of bias (due to high risk of bias arising from lack of blinding, high risk of selective reporting and lack of ability to check for publication bias) and two levels for very serious imprecision (single study with few events)). AUTHORS' CONCLUSIONS: This review shows that for selected, low-risk pregnant women, the evidence from randomised trials to support that planned hospital birth reduces maternal or perinatal mortality, morbidity, or any other critical outcome is uncertain. As the quality of evidence in favour of home birth from observational studies seems to be steadily increasing, it might be just as important to prepare a regularly updated systematic review including observational studies as described in the Cochrane Handbook for Systematic Reviews of Interventions as to attempt to set up new RCTs. As women and healthcare practitioners may be aware of evidence from observational studies, and as the International Federation of Gynecology and Obstetrics and the International Confederation of Midwives collaboratively conclude that there is strong evidence that out-of-hospital birth supported by a registered midwife is safe, equipoise may no longer exist, and randomised trials may now thus be considered unethical or hardly feasible.
Collapse
Affiliation(s)
- Ole Olsen
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen K, Denmark
| | | |
Collapse
|
2
|
Policies and Practices on Out-of-Hospital Birth: a Review of Qualitative Studies in the Time of Coronavirus. CURRENT SEXUAL HEALTH REPORTS 2023; 15:36-48. [PMID: 36530373 PMCID: PMC9735103 DOI: 10.1007/s11930-022-00354-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/12/2022] [Indexed: 12/13/2022]
Abstract
Purpose of Review The purpose of this review is to summarize the current knowledge on out-of-hospital births (at home or in an independent birth center) in high-income countries in the time of coronavirus. Qualitative studies published between 2020 and 2022 providing findings on women's and health providers' perspectives and experiences, as well as policies and practices implemented, are synthetized. Recent Findings During the COVID-19 pandemic, the number of women choosing the home or a birth center to deliver has grown considerably. Main reasons for this choice include fear of contagion in facilities and restrictions during delivery and the post-partum period, especially women's separation from their companion of choice and their newborn. Findings suggest that homebirth within a public model has several advantages in the experience of birth for both women and professionals during the pandemic period, maintaining the benefits of biomedicine when needed. Summary During the COVID-19 pandemic, the interest in out-of-hospital birth increased in high-income countries, and the number of women choosing the home or a birth center to deliver has grown considerably. This review aims to give a more in-depth understanding of women's and health providers' perspectives on and experiences of out-of-hospital birth services during this period. Twenty-five studies in different countries, including the USA, Canada, Australia, Switzerland, the Netherlands, the UK, Spain, Croatia, and Norway, were reviewed. Findings stress that out-of-hospital birth has allowed women to deliver according to their wishes and needs. In addition, the pandemic experience represents an opportunity for policy to better support and integrate out-of-hospital services in the health care system in the future.
Collapse
|
3
|
Rios-Quituizaca P, Gatica-Domínguez G, Nambiar D, Santos JL, Barros AJD. Ethnic inequalities in reproductive, maternal, newborn and child health interventions in Ecuador: A study of the 2004 and 2012 national surveys. EClinicalMedicine 2022; 45:101322. [PMID: 35284805 PMCID: PMC8904232 DOI: 10.1016/j.eclinm.2022.101322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2021] [Revised: 01/29/2022] [Accepted: 02/14/2022] [Indexed: 12/01/2022] Open
Abstract
BACKGROUND Analysis of health inequalities by ethnicity is critical to achieving the Sustainable Development Goals. In Ecuador, similar to other Latin American countries, indigenous and afro-descendant populations have long been subject to racism, discrimination, and inequitable treatment. Although in recent years, Ecuador has made progress in health indicators, particularly those related to the coverage of Reproductive, Maternal, Neonatal and Child Health (RMNCH) interventions, little is known as to whether inequalities by ethnicity persist. METHODS Analysis was based on two nationally representative health surveys (2004 and 2012). Ethnicity was self-reported and classified into three categories (Indigenous/Afro-Ecuadorian/Mixed ancestry). Coverage data for six RMNCH health interventions were stratified for each ethnic group by level of education, area of residence and wealth quintiles. Absolute inequality measures were computed and multivariate analysis using Poisson regression was undertaken. FINDINGS In 2012, 74.4% of women self-identifying as indigenous did not achieve the secondary level of education and 50.7% were in the poorest quintile (Q1); this profile was relatively unchanged since 2004. From 2004 to 2012, the coverage of RMNCH interventions increased for all ethnic groups, and absolute inequality decreased. However, in 2012, regardless of education level, area of residence and wealth quintiles, ethnic inequalities remained for almost all RMNCH interventions. Indigenous women had 24% lower prevalence of modern contraceptive use (Prevalence ratio [PR] = 0.76; 95% IC: 0.7-0.8); 28% lower prevalence of antenatal care (PR = 0.72; 95% IC: 0.6-0.8); and 35% lower prevalence of skilled birth attendance and institutional delivery (PR = 0.65; 95% IC: 0.6-0.7 and PR = 0.65; 95% IC: 0.6-0.7 respectively), compared with the majority ethnic group in the country. INTERPRETATION While the gaps have narrowed, indigenous people in Ecuador continue in a situation of structural racism and are left behind in terms of access to RMNCH interventions. Strategies to reduce ethnic inequalities in the coverage services need to be collaboratively redesigned/co-designed. FUNDING This paper was made possible with funds from the Bill & Melinda Gates Foundation [Grant Number: INV-007,594/OPP1148933].
Collapse
Key Words
- CI, confidence interval
- CVD, national survey of living conditions
- ECLAC, economic commission for Latin America and the Caribbean
- ENSANUT, national survey of health and nutrition (encuesta nacional de salud y nutrición)
- Ethnic groups
- Health care surveys
- Healthcare disparities
- ICEH, international center for equity in health
- INEC, national institute of statistics and censuses (instituto nacional de estadísticas y censos)
- LA, Latin America
- Maternal-child health services continuity of patient care
- PR, prevalence ratio
- RHS, reproductive health survey
- RMNCH, reproductive, maternal, neonatal and children
- UBN, unsatisfied basic needs or NBI, (acronym in Spanish) a multidimensional poverty measure
- WRA, women in reproductive age
Collapse
Affiliation(s)
- Paulina Rios-Quituizaca
- Facultad de Ciencias Medicas, Universidad Central del Ecuador. Facultad de Medicina de Ribeirao Preto, Universidad de São Paulo. La Armenia, Quito, Ecuador
- Corresponding author.
| | | | | | | | - Aluisio J D Barros
- International Center for Equity in Health, Universidade Federal de Pelotas, Brazil
| |
Collapse
|
4
|
Scarf VL, Rossiter C, Vedam S, Dahlen HG, Ellwood D, Forster D, Foureur MJ, McLachlan H, Oats J, Sibbritt D, Thornton C, Homer CSE. Maternal and perinatal outcomes by planned place of birth among women with low-risk pregnancies in high-income countries: A systematic review and meta-analysis. Midwifery 2018; 62:240-255. [DOI: 10.1016/j.midw.2018.03.024] [Citation(s) in RCA: 89] [Impact Index Per Article: 14.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2017] [Revised: 03/01/2018] [Accepted: 03/26/2018] [Indexed: 12/15/2022]
|
5
|
Broda A, Krüger J, Schinke S, Weber A. Determinants of choice of delivery place: Testing rational choice theory and habitus theory. Midwifery 2018; 63:33-38. [PMID: 29777966 DOI: 10.1016/j.midw.2018.04.023] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2017] [Revised: 04/24/2018] [Accepted: 04/30/2018] [Indexed: 10/17/2022]
Abstract
OBJECTIVE The current study uses two antipodal social science theories, the rational choice theory and the habitus theory, and applies these to describe how women choose between intraclinical (i.e., hospital-run birth clinics) and extraclinical (i.e., midwife-led birth centres or home births) delivery places. DESIGN, SETTING, PARTICIPANTS, MEASUREMENTS Data were collected in a cross-sectional questionnaire-based survey among 189 women. A list of 22 determinants, conceptualized to capture the two theoretical concepts, were rated on a 7-point Likert scale with 1 = unimportant to 7 = very important. The analytic method was structural equation modelling. A model was built, in which the rational choice theory and the habitus theory as latent variables predicted the choice of delivery place. FINDINGS With regards to the choice of delivery place, 89.3% of the women wanted an intraclinical and 10.7% an extraclinical delivery place at the time of their last child's birth. Significant differences between women with a choice of an intraclinical or extraclinical delivery place were found for 14 of the 22 determinants. In the structural equation model, rational choice theory determinants predicted a choice of intraclinical delivery and habitus theory determinants predicted a choice of extraclinical delivery. KEY CONCLUSIONS The two theories had diametrically opposed effects on the choice of delivery place. Women are more likely to decide on intraclinical delivery when arguments such as high medical standards, positive evaluations, or good advanced information are rated important. In contrast, women are more likely to decide on extraclinical delivery when factors such as family atmosphere during birth, friendliness of health care professionals, or consideration of the woman's interests are deemed important. IMPLICATIONS FOR PRACTICE A practical implication of our study is that intraclinical deliveries may be promoted by providing comprehensive information, data and facts on various delivery-related issues, while extraclinical deliveries may be fostered by healthcare professionals tailoring personal or social beliefs, attitudes and opinions. Our study advocates that legislation and policy- and decision-makers should support different delivery place options in order to accommodate the choices and preferences of different women. The study demonstrates the usefulness of theory for describing and explaining a complex decision-making process, here the choice of delivery place.
Collapse
Affiliation(s)
- Anja Broda
- Martin Luther University Halle-Wittenberg, Medical Faculty, Institute of Health and Nursing Sciences, Halle (Saale), Germany.
| | - Juliane Krüger
- Martin Luther University Halle-Wittenberg, Medical Faculty, Institute of Health and Nursing Sciences, Halle (Saale), Germany
| | - Stephanie Schinke
- Martin Luther University Halle-Wittenberg, Medical Faculty, Institute of Health and Nursing Sciences, Halle (Saale), Germany
| | - Andreas Weber
- Martin Luther University Halle-Wittenberg, Medical Faculty, Institute of Health and Nursing Sciences, Halle (Saale), Germany
| |
Collapse
|
6
|
van der Kooy J, Birnie E, Denktas S, Steegers EAP, Bonsel GJ. Planned home compared with planned hospital births: mode of delivery and Perinatal mortality rates, an observational study. BMC Pregnancy Childbirth 2017; 17:177. [PMID: 28595580 PMCID: PMC5465453 DOI: 10.1186/s12884-017-1348-y] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2015] [Accepted: 05/25/2017] [Indexed: 12/01/2022] Open
Abstract
Background To compare the mode of delivery between planned home versus planned hospital births and to determine if differences in intervention rates could be interpreted as over- or undertreatment. Methods Intervention and perinatal mortality rates were obtained for 679,952 low-risk women from the Dutch Perinatal Registry (2000–2007). Intervention was defined as operative vaginal delivery and/or caesarean section. Perinatal mortality was defined as the intrapartum and early neonatal mortality rate up to 7 days postpartum. Besides adjustment for maternal and care factors, we included for additional casemix adjustment: presence of congenital abnormality, small for gestational age, preterm birth, or low Apgar score. The techniques used were nested multiple stepwise logistic regression, and stratified analysis for separate risk groups. An intention-to-treat like analysis was performed. Results The intervention rate was lower in planned home compared to planned hospital births (10.9% 95% CI 10.8–11.0 vs. 13.8% 95% CI 13.6–13.9). Intended place of birth had significant impact on the likelihood to intervene after adjustment (planned homebirth (OR 0.77 95% CI. 0.75–0.78)). The mortality rate was lower in planned home births (0.15% vs. 0.18%). After adjustment, the interaction term home- intervention was significant (OR1.51 95% CI 1.25–1.84). In risk groups, a higher perinatal mortality rate was observed in planned home births. Conclusions The potential presence of over- or under treatment as expressed by adjusted perinatal mortality differs per risk group. In planned home births especially multiparous women showed universally lower intervention rates. However, the benefit of substantially fewer interventions in the planned home group seems to be counterbalanced by substantially increased mortality if intervention occurs.
Collapse
Affiliation(s)
- Jacoba van der Kooy
- Department of Obstetrics and Gynecology, Division of Obstetrics & Prenatal Medicine, Room Hs-408, Erasmus MC, PO Box 2040, 3000, CA, Rotterdam, The Netherlands.
| | - Erwin Birnie
- Institute of Health Policy and Management, Erasmus University Rotterdam, PO Box 1738, 3000, DR, Rotterdam, The Netherlands.,Academic Collaboration Mother and Child Care, Wilhelmina Child Hospital, University Medical Center Utrecht, Postbus 85090, 3508, AB, Utrecht, The Netherlands
| | - Semiha Denktas
- Department of Obstetrics and Gynecology, Division of Obstetrics & Prenatal Medicine, Room Hs-408, Erasmus MC, PO Box 2040, 3000, CA, Rotterdam, The Netherlands
| | - Eric A P Steegers
- Department of Obstetrics and Gynecology, Division of Obstetrics & Prenatal Medicine, Room Hs-408, Erasmus MC, PO Box 2040, 3000, CA, Rotterdam, The Netherlands
| | - Gouke J Bonsel
- University of Applied Sciences, Midwifery Academy Rotterdam (Verloskunde Academie Rotterdam), Dr. Molewaterplein 40, 3015, GD, Rotterdam, The Netherlands.,Academic Collaboration Mother and Child Care, Wilhelmina Child Hospital, University Medical Center Utrecht, Postbus 85090, 3508, AB, Utrecht, The Netherlands
| |
Collapse
|
7
|
van der Kooy J, de Graaf JP, Birnie DE, Denktas S, Steegers EAP, Bonsel GJ. Different settings of place of midwife-led birth: evaluation of a midwife-led birth centre. SPRINGERPLUS 2016; 5:786. [PMID: 27386272 PMCID: PMC4912546 DOI: 10.1186/s40064-016-2306-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/03/2016] [Accepted: 05/09/2016] [Indexed: 11/23/2022]
Abstract
Objectives The claimed advantages of home deliveries, including fewer medical interventions, are potentially counter balanced by the small additional risk on perinatal adverse outcome compared to hospital deliveries in low risk women. Homelike birth centres have been proposed a new setting for low risk women combining the advantages of home and hospital, resulting in lower intervention rates with equal safety. This paper addresses whether the introduction of a midwife-led birth centre adjacent to the hospital combines the advantages of home and hospital deliveries. Additionally, we investigate whether the introduction of a midwife-led birth centre leads to a different risk selection of women planning their delivery either at home, at the hospital or at the birth centre. Methods Anonymized data, between January 2007 and June 2012, was collected from the four participating midwife practices. Women (n = 5558) were categorized according to intended place of birth. Women’s characteristics and pregnancy outcomes were compared between the period before and after its introduction using Chi square and Fisher’s Exact tests. Direct and indirect standardized rates were calculated for different outcomes [(1) intrapartum and neonatal mortality (<24 h), (2) composite outcome of neonatal morbidities, (3) composite outcome of maternal morbidities, and (4) medical intervention], taking the period before introduction as reference. Results After the introduction of the birth centre a different risk selection was observed. Women’s characteristics were most unfavourable for intended birth centre births. Additionally, an higher neonatal risk load was seen within these women. After its introduction neonatal morbidities decreased (5.0 vs. 3.8 %) and maternal morbidities decreased (8.3 vs. 7.3 %). Interventions were about equal. Direct and indirect standardization provided similar results. Conclusion Neonatal morbidity and maternal morbidity tended to decrease, while overall intervention rates were unaffected. The introduction of the midwife-led birth centre seems to benefit the outcome of midwife-led deliveries. We interpret this change by the redistribution of the higher risk women among the low risk population intending birth at the birth centre instead of home.
Collapse
Affiliation(s)
- Jacoba van der Kooy
- Division of Obstetrics and Prenatal Medicine, Room Hs-408, Department of Obstetrics and Gynaecology, Erasmus MC, PO Box 2040, 3000 CA Rotterdam, The Netherlands
| | - Johanna P de Graaf
- Division of Obstetrics and Prenatal Medicine, Room Hs-408, Department of Obstetrics and Gynaecology, Erasmus MC, PO Box 2040, 3000 CA Rotterdam, The Netherlands
| | - Doctor Erwin Birnie
- Division of Obstetrics and Prenatal Medicine, Room Hs-408, Department of Obstetrics and Gynaecology, 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
| | - Semiha Denktas
- Division of Obstetrics and Prenatal Medicine, Room Hs-408, Department of Obstetrics and Gynaecology, Erasmus MC, PO Box 2040, 3000 CA Rotterdam, The Netherlands
| | - Eric A P Steegers
- Division of Obstetrics and Prenatal Medicine, Room Hs-408, Department of Obstetrics and Gynaecology, Erasmus MC, PO Box 2040, 3000 CA Rotterdam, The Netherlands
| | - Gouke J Bonsel
- Division of Obstetrics and Prenatal Medicine, Room Hs-408, Department of Obstetrics and Gynaecology, Erasmus MC, PO Box 2040, 3000 CA Rotterdam, The Netherlands ; Rotterdam Midwifery Academic (Verloskunde Academie Rotterdam), Dr. Molewaterplein 40, 3015 GD Rotterdam, The Netherlands ; Department of Public Health, Erasmus MC, PO Box 2040, 3000 CA Rotterdam, The Netherlands
| |
Collapse
|
8
|
Anwar S, Jan R, Qureshi RN, Rattani S. Perinatal women's perceptions about midwifery led model of care in secondary care hospitals in Karachi, Pakistan. Midwifery 2013; 30:e79-90. [PMID: 24290946 DOI: 10.1016/j.midw.2013.10.020] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2013] [Revised: 10/14/2013] [Accepted: 10/22/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVE the purpose of this study was to explore the perceptions and experiences of perinatal women who have availed of midwifery led model of care (MLC) at secondary care settings in Karachi, Pakistan. DESIGN a qualitative descriptive exploratory approach using semi-structured interviews. PARTICIPANTS a purposive sample of 10 women who had used MLC was enroled from each site. FINDINGS content analysis highlighted that 'women's satisfaction with MLC' emerged as the main theme and, under this theme, the six categories that emerged were: (1) the admired capability and maturity of midwives, (2) the affordability of midwifery services, (3) a personalised relationship, (4) the empowerment of women to make decisions, (5) presence, and (6) a voiced concern regarding lack of marketing of MLC. KEY CONCLUSIONS the study findings revealed that women had an overall feeling of satisfaction with the maternity care provided by the midwives. Mostly, women appreciated the midwives' expertise in providing maternity care. Majority of the women acknowledged the continuous presence of the midwives during childbirth and the women shared that they were empowered to make decisions related to their care. Most of the women indicated that marketing for MLC is scarce and insufficient. Majority of the women are even not aware of this model; therefore, it is imperative to create awareness and to provide MLC access to women through robust marketing. IMPLICATIONS FOR PRACTICE the findings of this study may help to advocate and provide women-friendly maternity care, by giving choice and control to women during childbirth, providing comfort to women by using fewer medical interventions, and promoting normality by attending spontaneous vaginal childbirths.
Collapse
Affiliation(s)
- Shahnaz Anwar
- Aga Khan University Hospital and School of Nursing and Midwifery, Stadium Road, Karachi, Pakistan.
| | - Rafat Jan
- Aga Khan University Hospital and School of Nursing and Midwifery, Stadium Road, Karachi, Pakistan
| | - Rahat Najam Qureshi
- Aga Khan University Hospital and School of Nursing and Midwifery, Stadium Road, Karachi, Pakistan
| | - Salma Rattani
- Aga Khan University Hospital and School of Nursing and Midwifery, Stadium Road, Karachi, Pakistan
| |
Collapse
|
9
|
Faucon C, Brillac T. [Planned home versus planned hospital births: adverse outcomes comparison by reviewing the international literature]. ACTA ACUST UNITED AC 2013; 41:388-93. [PMID: 23769011 DOI: 10.1016/j.gyobfe.2013.04.005] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2012] [Accepted: 04/24/2013] [Indexed: 10/26/2022]
Abstract
OBJECTIVE To assess the safety of planned home birth compared to hospital birth, in low-risk pregnancies. METHOD An international literature review was conducted. Mortality, adverse outcomes and medical interventions were compared. RESULTS Home birth was not associated with higher mortality rates, but with lower maternal adverse outcomes. Perinatal adverse outcomes are not significantly different at home and in hospital. Medical interventions are more frequent in hospital births. CONCLUSION Home birth attended by a well-trained midwife is not associated with increased mortality and morbidity rates, but with less medical interventions.
Collapse
Affiliation(s)
- C Faucon
- Département de médecine générale, 64 rue des Champs-Élysées, Toulouse, France.
| | | |
Collapse
|
10
|
Nove A, Berrington A, Matthews Z. The methodological challenges of attempting to compare the safety of home and hospital birth in terms of the risk of perinatal death. Midwifery 2012; 28:619-26. [DOI: 10.1016/j.midw.2012.07.009] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2012] [Revised: 07/04/2012] [Accepted: 07/18/2012] [Indexed: 11/25/2022]
|
11
|
Abstract
Some intrapartum care practices promote vaginal birth, whereas others may increase the risk for cesarean section. Electronic fetal monitoring and use of the Friedman graph to plot and monitor labor progress are associated with increasing the cesarean section rate. Continuous one-to-one support and midwifery management are associated with lower cesarean section rates. This article reviews the evidence that links specific intrapartum care practices to cesarean section. Strategies that can be implemented in the current social and cultural setting of obstetrics today are recommended.
Collapse
Affiliation(s)
- Tekoa L King
- Department of Obstetrics, Gynecology and Reproductive Sciences, University of California San Francisco, San Francisco, CA, USA.
| |
Collapse
|
12
|
Abstract
BACKGROUND Observational studies of increasingly better quality and in different settings suggest that planned home birth in many places can be as safe as planned hospital birth and with less intervention and fewer complications. This is an update of a Cochrane review first published in 1998. OBJECTIVES To assess the effects of planned hospital birth compared with planned home birth in selected low-risk women, assisted by an experienced midwife with collaborative medical back up in case transfer should be necessary. SEARCH METHODS We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (30 March 2012) and contacted editors and authors involved with possible trials. SELECTION CRITERIA Randomised controlled trials comparing planned hospital birth with planned home birth in low-risk women as described in the objectives. DATA COLLECTION AND ANALYSIS The two review authors as independently as possible assessed trial quality and extracted data. We contacted study authors for additional information. MAIN RESULTS Two trials met the inclusion criteria but only one trial involving 11 women provided some outcome data and was included. The evidence from this trial was of moderate quality and too small to allow conclusions to be drawn. AUTHORS' CONCLUSIONS There is no strong evidence from randomised trials to favour either planned hospital birth or planned home birth for low-risk pregnant women. However, the trials show that women living in areas where they are not well informed about home birth may welcome ethically well-designed trials that would ensure an informed choice. As the quality of evidence in favour of home birth from observational studies seems to be steadily increasing, it might be as important to prepare a regularly updated systematic review including observational studies as described in the Cochrane Handbook for Systematic Reviews of Interventions as to attempt to set up new randomised controlled trials.
Collapse
Affiliation(s)
- Ole Olsen
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen,Copenhagen K, Denmark. @gmail.com
| | | |
Collapse
|
13
|
C Warren F, R Abrams K, Golder S, J Sutton A. Systematic review of methods used in meta-analyses where a primary outcome is an adverse or unintended event. BMC Med Res Methodol 2012; 12:64. [PMID: 22553987 PMCID: PMC3528446 DOI: 10.1186/1471-2288-12-64] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2011] [Accepted: 04/16/2012] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Adverse consequences of medical interventions are a source of concern, but clinical trials may lack power to detect elevated rates of such events, while observational studies have inherent limitations. Meta-analysis allows the combination of individual studies, which can increase power and provide stronger evidence relating to adverse events. However, meta-analysis of adverse events has associated methodological challenges. The aim of this study was to systematically identify and review the methodology used in meta-analyses where a primary outcome is an adverse or unintended event, following a therapeutic intervention. METHODS Using a collection of reviews identified previously, 166 references including a meta-analysis were selected for review. At least one of the primary outcomes in each review was an adverse or unintended event. The nature of the intervention, source of funding, number of individual meta-analyses performed, number of primary studies included in the review, and use of meta-analytic methods were all recorded. Specific areas of interest relating to the methods used included the choice of outcome metric, methods of dealing with sparse events, heterogeneity, publication bias and use of individual patient data. RESULTS The 166 included reviews were published between 1994 and 2006. Interventions included drugs and surgery among other interventions. Many of the references being reviewed included multiple meta-analyses with 44.6% (74/166) including more than ten. Randomised trials only were included in 42.2% of meta-analyses (70/166), observational studies only in 33.7% (56/166) and a mix of observational studies and trials in 15.7% (26/166). Sparse data, in the form of zero events in one or both arms where the outcome was a count of events, was found in 64 reviews of two-arm studies, of which 41 (64.1%) had zero events in both arms. CONCLUSIONS Meta-analyses of adverse events data are common and useful in terms of increasing the power to detect an association with an intervention, especially when the events are infrequent. However, with regard to existing meta-analyses, a wide variety of different methods have been employed, often with no evident rationale for using a particular approach. More specifically, the approach to dealing with zero events varies, and guidelines on this issue would be desirable.
Collapse
Affiliation(s)
- Fiona C Warren
- Peninsula College of Medicine and Dentistry, St Luke’s Campus, University of Exeter, Exeter, EX1 2LU, UK
| | - Keith R Abrams
- Department of Health Sciences, Adrian Building, University of Leicester, University Road, Leicester, LE1 7RH, UK
| | - Su Golder
- Centre for Reviews and Dissemination (CRD), University of York, York, YO10 5DD, UK
| | - Alex J Sutton
- Department of Health Sciences, Adrian Building, University of Leicester, University Road, Leicester, LE1 7RH, UK
| |
Collapse
|
14
|
Jouhki MR. Choosing homebirth--the women's perspective. Women Birth 2011; 25:e56-61. [PMID: 22088677 DOI: 10.1016/j.wombi.2011.10.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2011] [Revised: 10/08/2011] [Accepted: 10/10/2011] [Indexed: 11/17/2022]
Abstract
OBJECTIVE To describe the decision-making process and birth experience of ten women in Finland who had planned to have a home birth. METHOD The data were collected by means of in-depth interviews in 2008 and were analyzed using qualitative content analysis. RESULTS Several reasons led to a decision to give birth at home. The main reasons were: previous birth experience, considering birth to be a natural process, increased autonomy, the home environment, intuition, the desire to choose the birth attendant, mistrust of the medical establishment and the opportunity to have the baby's siblings present at the birth. There were inhibiting and facilitating factors which influenced the women's decisions, and before making their decisions women sought out information about home birth. Home birth was an extremely positive experience and women highlighted their desire for the development of parent education to empower women in their preparations for birth. Full autonomy, the participation of family members, trust in one's ability to give birth and the absence of pharmacological pain relief were major contributors to the positive birth experience. The need for empowerment through parent education was highlighted in the interviews. CONCLUSION To the women of this study home birth was very positive experience in which the autonomy was the important factor. According to this study maternity care services do not respond to women's individual wishes and services should be offer more alternatives and should be more empowering.
Collapse
Affiliation(s)
- Maija-Riitta Jouhki
- Department of Nursing Science, School of Health Sciences, University of Tampere, Lääkärinkatu 1, 33014 Tampere, Finland.
| |
Collapse
|
15
|
Davis D, Baddock S, Pairman S, Hunter M, Benn C, Wilson D, Dixon L, Herbison P. Planned place of birth in New Zealand: does it affect mode of birth and intervention rates among low-risk women? Birth 2011; 38:111-9. [PMID: 21599733 DOI: 10.1111/j.1523-536x.2010.00458.x] [Citation(s) in RCA: 88] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Midwives providing care as lead maternity caregivers in New Zealand provide continuity of care to women who may give birth in a variety of settings, including home, primary units, and secondary and tertiary level hospitals. The purpose of this study was to compare mode of birth and intrapartum intervention rates for low-risk women planning to give birth in these settings under the care of midwives. METHODS Data for a cohort of low-risk women giving birth in 2006 and 2007 were extracted from the Midwifery Maternity Provider Organisation database. Mode of birth, intrapartum interventions, and neonatal outcomes were compared with results adjusted for age, parity, ethnicity, and smoking. RESULTS Women planning to give birth in secondary and tertiary hospitals had a higher risk of cesarean section, assisted modes of birth, and intrapartum interventions than similar women planning to give birth at home and in primary units. The risk of emergency cesarean section for women planning to give birth in a tertiary unit was 4.62 (95% CI: 3.66-5.84) times that of a woman planning to give birth in a primary unit. Newborns of women planning to give birth in secondary and tertiary hospitals also had a higher risk of admission to a neonatal intensive care unit (RR: 1.40, 95% CI: 1.05-1.87; RR: 1.78, 95% CI: 1.31-2.42) than women planning to give birth in a primary unit. CONCLUSIONS Planned place of birth has a significant influence on mode of birth and rates of intrapartum intervention in childbirth.
Collapse
Affiliation(s)
- Deborah Davis
- Centre for Midwifery, Child and Family Health at the University of Technology, Sydney, Australia
| | | | | | | | | | | | | | | |
Collapse
|
16
|
MacDorman MF, Declercq E, Menacker F. Trends and characteristics of home births in the United States by race and ethnicity, 1990-2006. Birth 2011; 38:17-23. [PMID: 21332770 DOI: 10.1111/j.1523-536x.2010.00444.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND After a gradual decline from 1990 to 2004, the percentage of births occurring at home in the United States increased by 5 percent in 2005 and that increase was sustained in 2006. The purpose of the study was to analyze trends and characteristics in home births in United States by race and ethnicity from 1990 to 2006. METHODS U.S. birth certificate data on home births were analyzed and compared with hospital births for a variety of demographic and medical characteristics. RESULTS From 1990 to 2006, both the number and percentage of home births increased for non-Hispanic white women, but declined for all other race and ethnic groups. In 2006, non-Hispanic white women were three to four times more likely to have a home birth than women of other race and ethnic groups. Home births were more likely than hospital births to occur to older, married women with singleton pregnancies and several previous children. For non-Hispanic white women, fewer home births than hospital births were born preterm, whereas for other race and ethnic groups a higher percentage of home births than hospital births were born preterm. For non-Hispanic white women, two-thirds of home births were delivered by midwives. In contrast, for other race and ethnic groups, most home births were delivered by either physicians or "other" attendants, suggesting that a higher proportion of these births may be unplanned home births because of emergency situations. CONCLUSIONS Differences in the risk profile of home births by race and ethnicity are consistent with previous research, suggesting that, compared with non-Hispanic white women, a larger proportion of non-Hispanic black and Hispanic home births represent unplanned, emergency situations.
Collapse
Affiliation(s)
- Marian F MacDorman
- Reproductive Statistics Branch, Division of Vital Statistics, National Center for Health Statistics, Centers for Disease Control and Prevention, Hyattsville, Maryland 20782, USA
| | | | | |
Collapse
|
17
|
Lindgren HE, Brink Å, Klinberg-Allvin M. Fear causes tears - perineal injuries in home birth settings. A Swedish interview study. BMC Pregnancy Childbirth 2011; 11:6. [PMID: 21244665 PMCID: PMC3034711 DOI: 10.1186/1471-2393-11-6] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2010] [Accepted: 01/18/2011] [Indexed: 11/10/2022] Open
Abstract
Background Perineal injury is a serious complication of vaginal delivery that has a severe impact on the quality of life of healthy women. The prevalence of perineal injuries among women who give birth in hospital has increased over the last decade, while it is lower among women who give birth at home. The aim of this study was to describe the practice of midwives in home birth settings with the focus on the occurrence of perineal injuries. Methods Twenty midwives who had assisted home births for between one and 29 years were interviewed using an interview guide. The midwives also had experience of working in a hospital delivery ward. All the interviews were tape-recorded and transcribed. Content analysis was used. Results The overall theme was "No rushing and tearing about", describing the midwives' focus on the natural process taking its time. The subcategories 1) preparing for the birth; 2) going along with the physiological process; 3) creating a sense of security; 4) the critical moment and 5) midwifery skills illuminate the management of labor as experienced by the midwives when assisting births at home. Conclusions Midwives who assist women who give birth at home take many things into account in order to minimize the risk of complications during birth. Protection of the woman's perineum is an act of awareness that is not limited to the actual moment of the pushing phase but starts earlier, along with the communication between the midwife and the woman.
Collapse
Affiliation(s)
- Helena E Lindgren
- School of Health and Social Science, Dalarna University, Falun, Sweden.
| | | | | |
Collapse
|
18
|
Abstract
Home births are physiological births and form part of the social model of birth. Doctors, traditionally, have been very fearful of out-of-hospital birth, and physiological births happen less frequently in obstetric units. Normal/physiological birth contributes to improving public health, and doctors are often not aware of the extent of this benefit. Normal birth leads to adaptive physiological function in the baby (endocrine, immune system, thyroid function, respiration, neurology, temperature regulation), more mother and baby bonding, and promotes higher breastfeeding rates, which in turn lead to better lifelong emotional and physical health in babies. Normal birth affirms health, promotes empowerment in mothers, and is a societal event that has been linked to promoting positive emotional qualities in society via the birthing hormone, oxytocin. Training within the medical model constrains doctors’ appreciation of normal birth. Experience of complications, a lack of awareness of the evidence surrounding home birth, compounded by failure to understand the concept of iatrogenesis, perpetuates fear of home birth among doctors.
Collapse
|
19
|
Nove A, Berrington A, Matthews Z. Characteristics Associated With Intending and Achieving a Planned Home Birth in the United Kingdom: An Observational Study of 515,777 Maternities in the North West Thames Region, 1988–2000. INTERNATIONAL JOURNAL OF CHILDBIRTH 2011. [DOI: 10.1891/2156-5287.1.2.100] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND AND OBJECTIVES: This study aims to identify factors that have an independent association with planned home birth. It investigates the social, demographic, and obstetric profile of those who choose home birth as compared with those choosing hospital birth. This crucial evidence is lacking in the U.K. context and is needed when comparing pregnancy outcomes of different birth settings. Otherwise, the comparison is problematic because observed differences in incidence of pregnancy outcomes may be due to the fact that different types of women choose different birth settings. It is important to understand these differences in order to control for them.METHOD: This is an observational study involving secondary analysis of computerized maternity records from 15 hospitals in the former North West Thames Regional Health Authority (RHA) area. All pregnancies that resulted in a live or stillbirth in the years 1988–2000 are included (N = 515,777). Two binary logistic regression models are used: one with intended place of birth at booking as the outcome and the other with actual place of birth as the outcome.RESULTS: Women who are parous, White European, aged 30 and older, living in a relatively affluent area, and partnered are most likely to intend a home birth. Among those who intend a home birth at the end of pregnancy, predictors of achieving a home birth include an uncomplicated and relatively short labor, being parous, a low-risk pregnancy, and being White European. The hospital providing maternity care predicts the outcome for both models.CONCLUSIONS: Key variables robustly predict an intention to deliver at home and the achievement of a planned home birth. Studies comparing the outcomes of different birth settings in the United Kingdom should control for these variables.
Collapse
|
20
|
Dahlen H, Schmied V, Tracy SK, Jackson M, Cummings J, Priddis H. Home birth and the National Australian Maternity Services Review: too hot to handle? Women Birth 2010; 24:148-55. [PMID: 21074508 DOI: 10.1016/j.wombi.2010.10.002] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2010] [Revised: 10/13/2010] [Accepted: 10/14/2010] [Indexed: 11/18/2022]
Abstract
BACKGROUND In February 2009 the Improving Maternity Services in Australia - The Report of the Maternity Services Review (MSR) was released, with the personal stories of women making up 407 of the more than 900 submissions received. A significant proportion (53%) of the women were said to have had personal experience with homebirth. Little information is provided on what was said about homebirth in these submissions and the decision by the MSR not to include homebirth in the funding and insurance reforms being proposed is at odds with the apparent demand for this option of care. METHOD Data for this study comprised 832 submissions to the MSR that are publicly available on the Commonwealth of Australia Department of Health and Aging website. All 832 submissions were downloaded, coded and then entered into NVivo. Content analysis was used to analyse the data that related to homebirth. FINDINGS 450 of the submissions were from consumers of maternity services (54%). Four hundred and seventy (60%) of the submissions mentioned homebirth. Overall there were 715 references to home birth in the submissions. The submissions mentioning homebirth most commonly discussed the 'Benefits' and 'Barriers' in accessing this option of care. Benefits to the baby, mother and family were described, along with the benefits obtained from having a midwife at the birth, receiving continuity of care and having a good birth experience. Barriers were described as not having access to a midwife, no funding, no insurance and lack of clinical privileging for midwives. CONCLUSION Many positive recommendations have come from the MSR, however the decision to exclude homebirth from these reforms is perplexing considering the large number of submissions describing the benefits of and barriers to homebirth in Australia. A concerning number of submissions discuss having had or having considered an unattended birth at home due to these barriers. Overall there is the belief that not enabling access to funded, insured homebirth in Australia is a violation of human rights. It appears that homebirth was considered by the MSR as 'too hot to handle' and by dismissing it as a minority issue the government sought to avoided dealing with homebirth as a 'sensitive and controversial issue.'
Collapse
Affiliation(s)
- H Dahlen
- School of Nursing and Midwifery, Family and Community Health Group, University of Western Sydney, Australia.
| | | | | | | | | | | |
Collapse
|
21
|
Abstract
OBJECTIVE Home births attended by certified nurse midwives (CNMs) make up an extremely small proportion of births in the United States (<1.0%) and are not supported by the American College of Obstetrics and Gynecology (ACOG). The primary objective of this analysis was to examine the safety of certified nurse midwife attended home deliveries compared with certified nurse midwife in-hospital deliveries in the United States as measured by the risk of adverse infant outcomes among women with term, singleton, vaginal deliveries. STUDY DESIGN United States linked birth and infant death files for the years 2000 to 2004 were used for the analysis. Adverse neonatal outcomes including death were determined by place of birth and attendant type for in-hospital certified nurse midwife, in-hospital 'other' midwife, home certified nurse midwife, home 'other' midwife, and free-standing birth center certified nurse midwife deliveries. RESULT For the 5-year period there were 1 237 129 in-hospital certified nurse midwife attended births; 17 389 in-hospital 'other' midwife attended births; 13 529 home certified nurse midwife attended births; 42 375 home 'other' midwife attended births; and 25 319 birthing center certified nurse midwife attended births. The neonatal mortality rate per 1000 live births for each of these categories was, respectively, 0.5 (deaths=614), 0.4 (deaths=7), 1.0 (deaths=14), 1.8 (deaths=75), and 0.6 (deaths=16). The adjusted odds ratio (95% confidence interval) for neonatal mortality for home certified nurse midwife attended deliveries vs in-hospital certified nurse midwife attended deliveries was 2.02 (1.18, 3.45). CONCLUSION Deliveries at home attended by CNMs and 'other midwives' were associated with higher risks for mortality than deliveries in-hospital by CNMs.
Collapse
|
22
|
Women's experiences of giving birth and making decisions whether to give birth at home when professional care at home is not an option in public health care. SEXUAL & REPRODUCTIVE HEALTHCARE 2010; 1:61-6. [PMID: 21122598 DOI: 10.1016/j.srhc.2010.02.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/30/2009] [Accepted: 02/01/2010] [Indexed: 11/21/2022]
Abstract
OBJECTIVE To describe women's experiences of giving birth and making decisions whether to give birth at home when professional care at home is not an option in public health care. METHOD A phenomenological study. Interviews with seven women; four of them gave birth at home without professional assistant and three at hospital. RESULTS The essential structure shows that women live with huge contrasts between an inner and outer image of birth. They express trust towards themselves and giving birth, as well as to their own decision whether hospital care is needed or not. Birth can be empowering and strengthening, and is of importance for bonding with the child. In contrast, an outer image coming from the public and healthcare is characterized by risk, danger and fear of childbirth. Birth is viewed as something draining. The women waited with their decision where to give birth, in some cases until the contractions have started. The women felt left alone and punished. They also met supportive midwives and physicians who represented a personal perspective. In contrast, as a group, they were experienced as insecure and representative for the healthcare system. CONCLUSION The implication is to meet, and give a secure care to women with contrasting views of childbirth and not only to the large majority. Midwives and physicians should establish a trustful relationship with the women and know that they can be experienced as trustful even if they do not express a positive attitude towards giving birth at home.
Collapse
|
23
|
Hollins Martin CJ, Bull P. The situational argument: do midwives agree or acquiesce with senior staff? J Reprod Infant Psychol 2010. [DOI: 10.1080/02646830903229876] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
|
24
|
McMURTRIE J, CATLING-PAUL C, TEATE A, CAPLICE S, CHAPMAN M, HOMER C. The St. George Homebirth Program: An evaluation of the first 100 booked women. Aust N Z J Obstet Gynaecol 2009; 49:631-6. [DOI: 10.1111/j.1479-828x.2009.01103.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
|
25
|
Hendrix MJ, Evers SM, Basten MC, Nijhuis JG, Severens JL. Cost analysis of the Dutch obstetric system: low-risk nulliparous women preferring home or short-stay hospital birth--a prospective non-randomised controlled study. BMC Health Serv Res 2009; 9:211. [PMID: 19925673 PMCID: PMC2784768 DOI: 10.1186/1472-6963-9-211] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2009] [Accepted: 11/19/2009] [Indexed: 11/18/2022] Open
Abstract
Background In the Netherlands, pregnant women without medical complications can decide where they want to give birth, at home or in a short-stay hospital setting with a midwife. However, a decrease in the home birth rate during the last decennium may have raised the societal costs of giving birth. The objective of this study is to compare the societal costs of home births with those of births in a short-stay hospital setting. Methods This study is a cost analysis based on the findings of a multicenter prospective non-randomised study comparing two groups of nulliparous women with different preferences for where to give birth, at home or in a short-stay hospital setting. Data were collected using cost diaries, questionnaires and birth registration forms. Analysis of the data is divided into a base case analysis and a sensitivity analysis. Results In the group of home births, the total societal costs associated with giving birth at home were €3,695 (per birth), compared with €3,950 per birth in the group for short-stay hospital births. Statistically significant differences between both groups were found regarding the following cost categories 'Cost of contacts with health care professionals during delivery' (€138.38 vs. €87.94, -50 (2.5-97.5 percentile range (PR)-76;-25), p < 0.05), 'cost of maternity care at home' (€1,551.69 vs. €1,240.69, -311 (PR -485; -150), p < 0.05) and 'cost of hospitalisation mother' (€707.77 vs. 959.06, 251 (PR 69;433), p < 0.05). The highest costs are for hospitalisation (41% of all costs). Because there is a relatively high amount of (partly) missing data, a sensitivity analysis was performed, in which all missing data were included in the analysis by means of general mean substitution. In the sensitivity analysis, the total costs associated with home birth are €4,364 per birth, and €4,541 per birth for short-stay hospital births. Conclusion The total costs associated with pregnancy, delivery, and postpartum care are comparable for home birth and short-stay hospital birth. The most important differences in costs between the home birth group and the short-stay hospital birth group are associated with maternity care assistance, hospitalisation, and travelling costs.
Collapse
Affiliation(s)
- Marijke Jc Hendrix
- Department of Obstetrics, GROW - School for Oncology and Development Biology, Maastricht UMC, PO Box 5800, 6202 AZ Maastricht, The Netherlands.
| | | | | | | | | |
Collapse
|
26
|
Hutton EK, Reitsma AH, Kaufman K. Outcomes associated with planned home and planned hospital births in low-risk women attended by midwives in Ontario, Canada, 2003-2006: a retrospective cohort study. Birth 2009; 36:180-9. [PMID: 19747264 DOI: 10.1111/j.1523-536x.2009.00322.x] [Citation(s) in RCA: 159] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND Midwives in Ontario, Canada, provide care in the home and hospital and are required to submit data for all births to the Ontario Ministry of Health database. The purpose of this study was to compare maternal and perinatal/neonatal mortality and morbidity and intrapartum intervention rates for women attended by Ontario midwives who planned a home birth compared with similar low-risk women who planned a hospital birth between 2003 and 2006. METHODS The database provided outcomes for all women planning a home birth at the onset of labor (n = 6,692) and for a cohort, stratified by parity, of similar low-risk women planning a hospital birth. RESULTS The rate of perinatal and neonatal mortality was very low (1/1,000) for both groups, and no difference was shown between groups in perinatal and neonatal mortality or serious morbidity (2.4% vs 2.8%; relative risk [RR], 95% confidence intervals [CI]: 0.84 [0.68-1.03]). No maternal deaths were reported. All measures of serious maternal morbidity were lower in the planned home birth group as were rates for all interventions including cesarean section (5.2% vs 8.1%; RR [95% CI]: 0.64 [0.56, 0.73]). Nulliparas were less likely to deliver at home, and had higher rates of ambulance transport from home to hospital than multiparas planning home birth and had rates of intervention and outcomes similar to, or lower than, nulliparas planning hospital births. CONCLUSIONS Midwives who were integrated into the health care system with good access to emergency services, consultation, and transfer of care provided care resulting in favorable outcomes for women planning both home or hospital births.
Collapse
Affiliation(s)
- Eileen K Hutton
- Faculty of Health Sciences, Midwifery Education Program, Department of Obstetrics and Gynecology, McMaster University, Hamilton, Canada
| | | | | |
Collapse
|
27
|
Gyte G, Dodwell M, Newburn M, Sandall J, Macfarlane A, Bewley S. Estimating intrapartum-related perinatal mortality rates for booked home births: when the 'best' available data are not good enough. BJOG 2009; 116:933-42. [PMID: 19522797 DOI: 10.1111/j.1471-0528.2009.02147.x] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
OBJECTIVE To critically appraise a recent study on the safety of home birth (Mori R, Dougherty M, Whittle M. BJOG 2008;115:554) and assess its contribution to the debate about risks and benefits of planned home birth for women at low risk of complications. DESIGN Critical appraisal of a published paper. SETTING England and Wales. POPULATION OR SAMPLE Home births from 1994-2003 and all women giving birth in the same time period. METHODS Six members of a multidisciplinary group appraised the paper independently. Comments were collated and synthesised. MAIN OUTCOME MEASURES Assessment of: overall methodology; assumptions used in estimating figures; methods used for calculations; conclusions drawn from the results and reliability and consistency of data. RESULTS Although there were some positive aspects to the study, there were weaknesses in design and an inaccurate estimate of risk. Our evidence suggests that the conclusions drawn did not reflect the results and the methodological weaknesses found in the study rendered both the results and conclusions invalid. CONCLUSIONS On the basis of our critical appraisal, the study does not contribute to the existing evidence about the safety of home birth to inform decision-making or provision of care. The limitations could have been identified by the peer review process and the problems were compounded by an inaccurate press release. Great care needs to be taken by journals to ensure the accuracy of information before dissemination to the scientific community, clinicians and the public. These data should not have been used to inform national guidelines.
Collapse
Affiliation(s)
- G Gyte
- Division of Perinatal and Reproductive Medicine, University of Liverpool, Liverpool Women's NHS Foundation Trust, Liverpool, UK.
| | | | | | | | | | | |
Collapse
|
28
|
Staying home to give birth: why women in the United States choose home birth. J Midwifery Womens Health 2009; 54:119-26. [PMID: 19249657 DOI: 10.1016/j.jmwh.2008.09.006] [Citation(s) in RCA: 122] [Impact Index Per Article: 8.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2008] [Revised: 09/16/2008] [Accepted: 09/16/2008] [Indexed: 11/21/2022]
Abstract
Approximately 1% of American women give birth at home and face substantial obstacles when they make this choice. This study describes the reasons that women in the United States choose home birth. A qualitative descriptive secondary analysis was conducted in a previously collected dataset obtained via an online survey. The sample consisted of 160 women who were US residents and planned a home birth at least once. Content analysis was used to study the responses from women to one essay question: "Why did you choose home birth?" Women who participated in the study were mostly married (91%) and white (87%). The majority (62%) had a college education. Our analysis revealed 508 separate statements about why these women chose home birth. Responses were coded and categorized into 26 common themes. The most common reasons given for wanting to birth at home were: 1) safety (n = 38); 2) avoidance of unnecessary medical interventions common in hospital births (n = 38); 3) previous negative hospital experience (n = 37); 4) more control (n = 35); and 5) comfortable, familiar environment (n = 30). Another dominant theme was women's trust in the birth process (n = 25). Women equated medical intervention with reduced safety and trusted their bodies' inherent ability to give birth without interference.
Collapse
|
29
|
Bhutta ZA, Darmstadt GL, Haws RA, Yakoob MY, Lawn JE. Delivering interventions to reduce the global burden of stillbirths: improving service supply and community demand. BMC Pregnancy Childbirth 2009; 9 Suppl 1:S7. [PMID: 19426470 PMCID: PMC2679413 DOI: 10.1186/1471-2393-9-s1-s7] [Citation(s) in RCA: 107] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND Although a number of antenatal and intrapartum interventions have shown some evidence of impact on stillbirth incidence, much confusion surrounds ideal strategies for delivering these interventions within health systems, particularly in low-/middle-income countries where 98% of the world's stillbirths occur. Improving the uptake of quality antenatal and intrapartum care is critical for evidence-based interventions to generate an impact at the population level. This concluding paper of a series of papers reviewing the evidence for stillbirth interventions examines the evidence for community and health systems approaches to improve uptake and quality of antenatal and intrapartum care, and synthesises programme and policy recommendations for how best to deliver evidence-based interventions at community and facility levels, across the continuum of care, to reduce stillbirths. METHODS We systematically searched PubMed and the Cochrane Library for abstracts pertaining to community-based and health-systems strategies to increase uptake and quality of antenatal and intrapartum care services. We also sought abstracts which reported impact on stillbirths or perinatal mortality. Searches used multiple combinations of broad and specific search terms and prioritised rigorous randomised controlled trials and meta-analyses where available. Wherever eligible randomised controlled trials were identified after a Cochrane review had been published, we conducted new meta-analyses based on the original Cochrane criteria. RESULTS In low-resource settings, cost, distance and the time needed to access care are major barriers for effective uptake of antenatal and particularly intrapartum services. A number of innovative strategies to surmount cost, distance, and time barriers to accessing care were identified and evaluated; of these, community financial incentives, loan/insurance schemes, and maternity waiting homes seem promising, but few studies have reported or evaluated the impact of the wide-scale implementation of these strategies on stillbirth rates. Strategies to improve quality of care by upgrading the skills of community cadres have shown demonstrable impact on perinatal mortality, particularly in conjunction with health systems strengthening and facilitation of referrals. Neonatal resuscitation training for physicians and other health workers shows potential to prevent many neonatal deaths currently misclassified as stillbirths. Perinatal audit systems, which aim to improve quality of care by identifying deficiencies in care, are a quality improvement measure that shows some evidence of benefit for changes in clinical practice that prevent stillbirths, and are strongly recommended wherever practical, whether as hospital case review or as confidential enquiry at district or national level. CONCLUSION Delivering interventions to reduce the global burden of stillbirths requires action at all levels of the health system. Packages of interventions should be tailored to local conditions, including local levels and causes of stillbirth, accessibility of care and health system resources and provider skill. Antenatal care can potentially serve as a platform to deliver interventions to improve maternal nutrition, promote behaviour change to reduce harmful exposures and risk of infections, screen for and treat risk factors, and encourage skilled attendance at birth. Following the example of high-income countries, improving intrapartum monitoring for fetal distress and access to Caesarean section in low-/middle-income countries appears to be key to reducing intrapartum stillbirth. In remote or low-resource settings, families and communities can be galvanised to demand and seek quality care through financial incentives and health promotion efforts of local cadres of health workers, though these interventions often require simultaneous health systems strengthening. Perinatal audit can aid in the development of better standards of care, improving quality in health systems. Effective strategies to prevent stillbirth are known; gaps remain in the data, the evidence and perhaps most significantly, the political will to implement these strategies at scale.
Collapse
Affiliation(s)
- Zulfiqar A Bhutta
- Division of Maternal and Child Health, The Aga Khan University, Karachi, Pakistan
| | - Gary L Darmstadt
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | - Rachel A Haws
- Department of International Health, Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland, USA
| | | | - Joy E Lawn
- Saving Newborn Lives/Save the Children-US, Cape Town, South Africa
- International Perinatal Care Unit, Institute of Child Health, London, UK
- Health Systems Research Unit, Medical Research Council of South Africa, South Africa
| |
Collapse
|
30
|
Martin CJH, Bull P. Protocols, policy directives and choice provision: UK midwives' views. Int J Health Care Qual Assur 2009; 22:55-66. [PMID: 19284171 DOI: 10.1108/09526860910927952] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
PURPOSE Within maternity hospitals midwives are expected to follow the protocol-driven culture and orders issued by senior staff. Simultaneously, midwives are expected to follow social policy documents and the Midwives Rules and Standards that advocate choice provision for childbearing women. Quality assurors and auditors of clinical practice need to be aware that these two directives sometimes clash. Allegiance to a hierarchical system driven by protocols and orders from the top down, at the same time as providing "woman-centred" care is often unattainable. In order for a midwife to action the woman's choice, resourceful thinking may be required. This paper aims to examine this issue. DESIGN/ METHODOLOGY/APPROACH: A descriptive interview study set out to discover strategies which midwives use to resolve conflict produced from competing directives. An appraisal of 20 midwives' views were gained from semi-structured interviews conducted in seven maternity units in the UK. Taking a post-positivist approach, inductive thematic analysis was used to interpret the data. FINDINGS Three main categories represented resourceful ways of pleasing both authority and the childbearing woman. Midwives occasionally: are economical with the truth; circumvent face-to-face confrontation with senior staff; and persuade women to refuse what they perceive are unnecessary and invasive interventions. ORIGINALITY/VALUE This paper offers unique insights into methods that midwives use to resolve conflicts in direction issued by management. It is important that auditors are aware that midwives sometimes struggle to support the preferences of healthy childbearing women. This reduces job satisfaction, delivery of care and consequently requires address.
Collapse
|
31
|
Lindgren HE, Hildingsson IM, Christensson K, Rådestad IJ. Transfers in planned home births related to midwife availability and continuity: a nationwide population-based study. Birth 2008; 35:9-15. [PMID: 18307482 DOI: 10.1111/j.1523-536x.2007.00206.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND Planning a home birth does not necessarily mean that the birth will take place successfully at home. The object of this study was to describe reasons and risk factors for transfer to hospital during or shortly after a planned home birth. METHODS A nationwide study including all women who had given birth at home in Sweden between January 1, 1992, and July 31, 2005. A total of 735 women had given birth to 1,038 children. One questionnaire for each planned home birth was sent to the women. Of the 1,038 questionnaires, 1,025 were returned. Reasons for transfer and obstetric, socioeconomic, and care-related risk factors for being transferred were measured using logistic regression. RESULTS Women were transferred in 12.5 percent of the planned home births. Transfers were more common among primiparas compared with multiparas (relative risk [RR] 2.5; 95% CI 1.8-3.5). Failure to progress and unavailability of the chosen midwife at the onset of labor were the reasons for 46 and 14 percent of transfers, respectively. For primiparas, the risk was four times greater if a midwife other than the one who carried out the prenatal checkups assisted at the birth (RR 4.4; 95% CI 2.1-9.5). A pregnancy exceeding 42 weeks increased the risk of transfer for both primiparas (RR 3.0; 95% CI 1.1-9.4) and multiparas (RR 3.4; 95% CI 1.3-9.0). CONCLUSIONS The most common reasons for transfer to hospital during or shortly after delivery were failure to progress followed by the midwife's unavailability at the onset of labor. Primiparas whose midwife for checkups during pregnancy was different from the one who assisted at the home birth were at increased risk of being transferred.
Collapse
Affiliation(s)
- Helena E Lindgren
- Division for Reproductive and Perinatal Health, Department of Woman and Child Health, Karolinska University, Stockholm
| | | | | | | |
Collapse
|
32
|
Block J. Reply to 'Must maternity medicine be reborn?'. Nat Med 2007. [DOI: 10.1038/nm1107-1275a] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
|
33
|
Abstract
The UK government claims it is trying to give women more choice by converting local maternity units to midwife led services. Lesley Page believes such units improve the birth experience, but Jim Drife remains worried about the risks of delivering outside hospital
Collapse
Affiliation(s)
- Lesley Page
- Florence Nightingale School of Nursing and Midwifery, King's College London, London SE1 9NH.
| |
Collapse
|
34
|
Cheyne H, Dowding D, Hundley V, Aucott L, Styles M, Mollison J, Greer I, Niven C. The development and testing of an algorithm for diagnosis of active labour in primiparous women. Midwifery 2007; 24:199-213. [PMID: 17337315 DOI: 10.1016/j.midw.2006.12.005] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2006] [Revised: 10/16/2006] [Accepted: 12/17/2006] [Indexed: 12/26/2022]
Abstract
OBJECTIVES to describe the development and testing of an algorithm for diagnosis of active labour in primiparous women. DESIGN qualitative and quantitative methods were used. A literature review was first conducted to identify the key cues for inclusion in the algorithm. Focus groups of midwives were then conducted to assess content validity, finally a vignette study assessed the inter-rater reliability of the algorithm. SETTING midwives from two study sites were invited to participate. Data were collected during 2002 and 2003. PARTICIPANTS midwives from the first site took part in the focus groups (n=13), completed vignettes (n=19), or both. Midwives from the second site then completed vignettes (n=17). FINDINGS an algorithm, developed from the key informational cues reported in the literature, was validated in relation to content validity by the findings from the focus groups. Inter-rater reliability was tested using vignettes of admission case histories and was found to be moderate in the first test (K=0.45). However, after modifying the algorithm the kappa score was 0.86, indicating a high level of agreement. KEY CONCLUSIONS diagnosis of labour may be straightforward on paper but is frequently problematic in practice. This may be because the diagnosis of labour is made in a high pressured environment where conflicting pressures of workload, limited resources and emotional pressures add to the complexity of the judgement. IMPLICATIONS FOR PRACTICE we offer a valid and reliable decision-support tool as an aid for diagnosis of labour. The evaluation of the implementation of this tool is under way and will determine whether it is effective in reducing unnecessary admissions and improving clinical outcomes for women.
Collapse
Affiliation(s)
- Helen Cheyne
- University of Stirling, Stirling, FK9 4LA, Scotland, UK.
| | | | | | | | | | | | | | | |
Collapse
|
35
|
Borquez HA, Wiegers TA. A comparison of labour and birth experiences of women delivering in a birthing centre and at home in the Netherlands. Midwifery 2006; 22:339-47. [PMID: 16647170 DOI: 10.1016/j.midw.2005.12.004] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2004] [Revised: 12/08/2004] [Accepted: 12/22/2005] [Indexed: 11/23/2022]
Abstract
OBJECTIVE to compare the labour and birth experiences of women who delivered at home without complications with the experiences of women who delivered in a birth centre without complications. DESIGN a descriptive study using postal questionnaires at 1-6 months after birth of a consecutive sample of postpartum women. SETTING women were recruited from one birth centre and three midwifery practices in an urban area of the Netherlands between September and December 2003. PARTICIPANTS 193 women; 129 delivered at home and 64 delivered in the birth centre. FINDINGS the home-birth group perceived less pain (mean score home birth 6.291, birth-centre birth 6.977), desired less pain-relieving medication (home birth 7.9%, birth-centre birth 21.9%), believed they knew their midwife better (home birth 36%, birth-centre birth 10% 'knew her well'), and rated their birth setting 'higher' than the birth-centre group (mean score home birth 4.70, birth-centre birth 4.01). Furthermore, the birth-centre group emphasised safety, having medical help available, and convenience, whereas the home-birth group placed more importance on the home being trustworthy and dependable, having their own place and belongings, and feeling comfortable and relaxed. KEY CONCLUSIONS having an understanding of a woman's labour and delivery experience allows health-care providers to continue to improve the quality of maternity care. The environment can have a positive effect on a woman's birth experience; recommendations have been proposed that can be applied to all pregnant and labouring women. IMPLICATIONS FOR PRACTICE identification and understanding of the factors in the environment that make the labour and birth experience more positive should be incorporated into the education and preparation for an upcoming birth.
Collapse
Affiliation(s)
- Heather A Borquez
- Netherlands Institute for Health Services Research (NIVEL), PO Box 1568, 3500 BN, Utrecht, the Netherlands.
| | | |
Collapse
|
36
|
Mead M, Bogaerts A, Reyns M. Midwives' perception of the intrapartum risk of healthy nulliparae in spontaneous labour, in The Flanders, Belgium. Midwifery 2006; 23:361-71. [PMID: 17126968 DOI: 10.1016/j.midw.2006.05.003] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2006] [Revised: 05/18/2006] [Accepted: 05/18/2006] [Indexed: 11/25/2022]
Abstract
OBJECTIVE to explore midwives' perception of intrapartum risk for healthy nulliparous women in spontaneous labour at term of a healthy singleton pregnancy, in the Belgian Flanders, and to compare these results with those of a previous study undertaken in England. DESIGN survey of the care midwives would advocate and their perception of intrapartum risk using a standardised scenario. This study replicates part of a survey undertaken with British midwives (Mead & Kornbrot 2004b). With an added section to capture the particulars of the Belgian situation and explore the likelihood of midwives being fully responsible for the whole intrapartum care of healthy women, including their delivery. The questionnaire was translated into Dutch by MR and distributed by the Flemish Midwives' Association (Vlaamse Organisatie van Vroedvrouwen-VLOV). PARTICIPANTS all 845 midwives and 143 student midwives who were members of VLOV were sent a questionnaire with their invitation to take part in their annual conference. Two hundred and seventy-five midwives and 107 students attended the conference, and 128 questionnaires were returned at the conference: 99 midwives (36% of the attendees), 26 students (24% of attendees), with three unidentified respondents. This convenience sample represented 12% of all midwives and 18% of all students. ANALYSIS SPSS for Windows was used for the statistical analysis. Descriptive statistics were used and differences between categorical variables were analysed using chi(2) and Fisher's Exact tests, and differences between continuous variables were analysed by analysis of variance. FINDINGS midwives generally described a more medicalised approach to intrapartum care on admission and during the first stage of labour than their British counterparts, but were much more optimistic about the chances of healthy women in spontaneous labour achieving a normal delivery within 12 hours. However, Belgian midwives had only a limited ability to undertake normal deliveries because of the high proportion of obstetricians who fulfil this responsibility. This contravenes the European Union (EU) directive on the activities of the midwife. KEY CONCLUSIONS despite much greater involvement of obstetricians in the care, of women suitable for full midwifery care, and a more medicalised approach to intrapartum care, the Belgian Flanders have a significantly lower caesarean section rate than the UK. The inability of Belgian midwives to fulfil the activities of the midwives as identified by the EU directives raises questions about the migration of midwives trained in Belgium to other EU member states.
Collapse
Affiliation(s)
- Mariane Mead
- Human Sciences Research Institute, University of Hertfordshire, College Lane, Hatfield, Herts AL10 9AB, UK.
| | | | | |
Collapse
|
37
|
Murphy PA, Fullerton JT. Development of the Optimality Index as a New Approach to Evaluating Outcomes of Maternity Care. J Obstet Gynecol Neonatal Nurs 2006; 35:770-8. [PMID: 17105643 DOI: 10.1111/j.1552-6909.2006.00105.x] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
Abstract
Evaluating perinatal outcomes within a framework of normalcy is a new focus of measurement. As maternal and child health clinicians and researchers look to evaluate care practices that are both of high quality and cost-effective, it is important to have measurement tools that assess differences among all women giving birth. The Optimality Index-US shifts the focus from rare adverse events to evidence-based optimal events. This article describes the continuing development of the index and discusses clinical implications for obstetric nurse clinicians.
Collapse
|
38
|
Cheyne H, Dowding DW, Hundley V. Making the diagnosis of labour: midwives' diagnostic judgement and management decisions. J Adv Nurs 2006; 53:625-35. [PMID: 16553671 DOI: 10.1111/j.1365-2648.2006.03769.x] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
AIM This paper reports a study examining midwives' perceptions of the way in which they diagnose labour. BACKGROUND Diagnosis of active labour is often problematic. A midwifery workforce planning tool identified that up to 30% of women admitted to United Kingdom labour wards subsequently turned out not to have been in labour. There is evidence that if a woman is admitted to a labour ward in early labour, she is more likely to have some form of medical intervention. However, despite the impact of misdiagnosis, there is little research on the process of decision-making by midwives in relation to diagnosis of labour. METHODS This was a qualitative study, employing focus group methods. Participants were a convenience sample of midwives working in a maternity unit in the North of England during 2002. They were asked to discuss their experience of admission of women in labour. Data were analysed using latent content analysis. FINDINGS Thirteen midwives participated in one of two groups. They described using information cues, which could be separated into two categories: those arising from the woman (Physical signs, Distress and coping, Woman's expectations and Social factors) and those from the institution (Midwifery care, Organizational factors and Justifying actions). Midwives' decision-making process could be divided into two stages. The diagnostic judgement was based on the physical signs of labour: the management decision would then be made by considering the diagnostic judgement as well as cues such as how the woman was coping, her expectations and those of her family and the requirements of the institution. CONCLUSIONS Midwives may experience more difficulty with the management decision than with the initial diagnosis. It may be that the number of inappropriate admissions to labour wards could be reduced by supporting midwives to negotiate the complex management hurdles, which accompany diagnosis of labour.
Collapse
Affiliation(s)
- Helen Cheyne
- Nursing, Midwifery and Allied Health Professions Research Unit, University of Stirling, Stirling, UK.
| | | | | |
Collapse
|
39
|
|
40
|
Abstract
A childbirth educator expresses frustration with a medical system that does not work for women or for many maternity care providers. She suggests out-of-hospital birth as an alternative. This column explores the safety of home birth, women's experiences of home birth, and the issues related to home birth once again being the standard. Childbirth educators are encouraged to present home birth as a viable choice.
Collapse
Affiliation(s)
- Judith A Lothian
- JUDITH A. LOTHIAN is a childbirth educator in Brooklyn, New York, and a member of the Lamaze International Board of Directors. She is also an associate professor in the College of Nursing at Seton Hall University in South Orange, New Jersey
| |
Collapse
|
41
|
Lindgren H, Hildingsson I, Rådestad I. A Swedish interview study: parents' assessment of risks in home births. Midwifery 2005; 22:15-22. [PMID: 16125827 DOI: 10.1016/j.midw.2005.04.002] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2004] [Revised: 04/06/2005] [Accepted: 04/12/2005] [Indexed: 10/25/2022]
Abstract
OBJECTIVE to describe home-birth risk assessment by parents. DESIGN interviews using a semi-structured interview guide. Data were analysed using a phenomenological approach. SETTING independent midwifery practices in Sweden. PARTICIPANTS five couples who had had planned home births. FINDINGS the parents had a fundamental trust that the birth would take place without complications, and they experienced meaningfulness in the event itself. Risks were considered to be part of a complex phenomenon that was not limited to births at home. This attitude seems to be part of a lifestyle that has a bearing on how risks experienced during the birth were handled. Five categories were identified as counterbalancing the risk of possible complications: (1) trust in the woman's ability to give birth; (2) trust in intuition; (3) confidence in the midwife; (4) confidence in the relationship; and (5) physical and intellectual preparation. KEY CONCLUSIONS although the parents were conscious of the risk of complications during childbirth, a fundamental trust in the woman's independent ability to give birth was central to the decision to choose a home birth. Importance was attached to the expected positive effects of having the birth at home. IMPLICATIONS FOR PRACTICE knowledge of parents' assessment can promote an increased understanding of how parents-to-be experience the risks associated with home birth.
Collapse
Affiliation(s)
- Helena Lindgren
- Department of Caring and Public Health Sciences, Mälardalen University, Box 325, S-63105 Eskilstuna, Sweden.
| | | | | |
Collapse
|
42
|
Outcomes of planned home births with certified professional midwives: large prospective study in North America. BMJ : BRITISH MEDICAL JOURNAL 2005; 330:1416. [PMID: 15961814 DOI: 10.1136/bmj.330.7505.1416] [Citation(s) in RCA: 143] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To evaluate the safety of home births in North America involving direct entry midwives, in jurisdictions where the practice is not well integrated into the healthcare system. DESIGN Prospective cohort study. SETTING All home births involving certified professional midwives across the United States (98% of cohort) and Canada, 2000. PARTICIPANTS All 5418 women expecting to deliver in 2000 supported by midwives with a common certification and who planned to deliver at home when labour began. MAIN OUTCOME MEASURES Intrapartum and neonatal mortality, perinatal transfer to hospital care, medical intervention during labour, breast feeding, and maternal satisfaction. RESULTS 655 (12.1%) women who intended to deliver at home when labour began were transferred to hospital. Medical intervention rates included epidural (4.7%), episiotomy (2.1%), forceps (1.0%), vacuum extraction (0.6%), and caesarean section (3.7%); these rates were substantially lower than for low risk US women having hospital births. The intrapartum and neonatal mortality among women considered at low risk at start of labour, excluding deaths concerning life threatening congenital anomalies, was 1.7 deaths per 1000 planned home births, similar to risks in other studies of low risk home and hospital births in North America. No mothers died. No discrepancies were found for perinatal outcomes independently validated. CONCLUSIONS Planned home birth for low risk women in North America using certified professional midwives was associated with lower rates of medical intervention but similar intrapartum and neonatal mortality to that of low risk hospital births in the United States.
Collapse
|
43
|
Anthony S, Buitendijk SE, Offerhaus PM, Dommelen P, Pal-de Bruin KM. Maternal factors and the probability of a planned home birth. BJOG 2005; 112:748-53. [PMID: 15924531 DOI: 10.1111/j.1471-0528.2004.00520.x] [Citation(s) in RCA: 31] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
OBJECTIVES In the Netherlands, approximately one-third of births are planned home births, mostly supervised by a midwife. The relationship between maternal demographic factors and home births supervised by midwives was examined. DESIGN Cross-sectional study. Setting Dutch national perinatal registries of the year 2000. POPULATION All women starting their pregnancy care under the supervision of a midwife, because these women have the possibility of having a planned home birth. METHODS The possible groups of birth were as follows: planned home birth or short stay hospital birth, both under the supervision of a midwife, or hospital birth under the supervision of an obstetrician after referral from the midwife during pregnancy or birth. The studied demographic factors were maternal age, parity, ethnicity and degree of urbanisation. Probabilities of having a planned home birth were calculated for women with different demographic profiles. MAIN OUTCOME MEASURE Place of birth. RESULTS In all age groups, the planned home birth percentage in primiparous women was lower than in multiparous women (23.5%vs 42.8%). A low home birth percentage was observed in women younger than 25 years. Dutch and non-Dutch women showed almost similar percentages of obstetrician-supervised hospital births but large differences in percentage of planned home births (36.5%vs 17.3%). Fewer home births were observed in large cities (30.5%) compared with small cities (35.7%) and rural areas (35.8%). CONCLUSIONS This study demonstrates a clear relationship between maternal demographic factors and the place of birth and type of caregiver and therefore the probability of a planned home birth.
Collapse
Affiliation(s)
- S Anthony
- TNO Prevention and Health, Department of Reproduction and Perinatology, Leiden, The Netherlands
| | | | | | | | | |
Collapse
|
44
|
Abstract
Routine care in normal labour may range from supportive care at home to intensive monitoring and multiple interventions in hospital. Good evidence of effectiveness is necessary to justify interventions in the normal process of labour. Inadequate evidence is available to support perineal shaving, routine enemas, starvation in labour and excluding the choice for home births. Evidence supports continuity of care led by midwives, companionship in labour, restricting the use of episiotomy, and active management of the third stage of labour, including routine use of 10 units of oxytocin. Both benefits and risks are associated with routine amniotomy, continuous electronic fetal heart rate monitoring, epidural analgesia, and oxytocin-ergometrine to prevent postpartum haemorrhage. More evidence is needed regarding the emotional consequences of labour interventions, home births, vaginal cleansing, opioid use, the partograph, second-stage labour techniques, misoprostol for primary prevention of postpartum haemorrhage, and strategies to promote evidence-based care in labour.
Collapse
Affiliation(s)
- G J Hofmeyr
- Effective Care Research Unit, East London Hospital Complex, University of the Witwatersrand/University of Fort Hare/Eastern Cape Department of Health, P Bag x9047, East London 5201, South Africa.
| |
Collapse
|
45
|
van Der Hulst LAM, van Teijlingen ER, Bonsel GJ, Eskes M, Bleker OP. Does a pregnant woman's intended place of birth influence her attitudes toward and occurrence of obstetric interventions? Birth 2004; 31:28-33. [PMID: 15015990 DOI: 10.1111/j.0730-7659.2004.0271.x] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND A home confinement with midwifery care is still an integral part of Dutch maternity care. It has been argued that the existence of home birth itself influences the course of the birth process positively, which is why obstetric interventions are low in comparison with neighboring countries. This study examined the impact of women's intended place of birth (home or hospital) and the course of pregnancy and labor when attended by midwives. METHODS This is a prospective study of 625 low-risk pregnant women, gestation 20 to 24 weeks, enrolled in 25 independently working midwifery practices. The course of labor was measured by the frequency of interventions by midwives and obstetricians. RESULTS A more non-technological approach to childbirth was observed within the women opting for a home birth compared with the women opting for a hospital birth. Data showed a relationship between interventions and planned birth site: sweeping membranes and amniotomy by midwives were more likely to be conducted in women opting for a home birth. Multiparas opting for hospital birth were more likely to experience consultations and referrals. Within the group of multiparas referred for obstetrician care, women intending to have a home birth experienced fewer interventions (e.g., induction, augmentation, pharmacologic pain relief, assisted delivery, cesarean section) compared with those who had opted for a hospital birth. CONCLUSIONS A large proportion of women desire a home birth. The impact of that choice demonstrated a smoother course of the birth process, compared with women who desired to deliver in the hospital, as measured by fewer obstetric interventions. We suggest that psychological factors (expectation and perceptions) influence both a woman's decision of birthplace and the actual birth process.
Collapse
Affiliation(s)
- Leonie A M van Der Hulst
- Department of Obstetrics and Gynecology, Academic Medical Center, University of Amsterdam, The Netherlands
| | | | | | | | | |
Collapse
|
46
|
|
47
|
Hartley H, Gasbarro C. Forces promoting health insurance coverage of homebirth: a case study in Washington State. Women Health 2003; 36:13-30. [PMID: 12539790 DOI: 10.1300/j013v36n03_02] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The movement of childbirth to the hospital in the early 1900s and the eventual establishments of health insurance reimbursement for hospital birth--but not for homebirth--solidified and reflected physician dominance in the area of obstetrics. Until recently, it was rare that a health insurer or a health maintenance organization (HMO) would cover a homebirth. However, in Washington State the majority of health insurance groups cover homebirths, which are generally attended by licensed midwives. In this context, our research is a case study focused on answering the question: What are the forces promoting the extensive coverage of homebirth by health insurers in Washington State? Data were gathered primarily through fourteen (14) in-depth, audiotaped interviews with key informants in relevant agencies and organizations in the state (i.e., state offices; midwife and other professional associations; and health insurance groups). Results suggest that consumer demand was an important precipitating factor without which changes to health insurance coverage would likely not have been made. Additionally, changes in state policies and professional mobilization on the part of licensed midwives were critical factors facilitating the widespread reimbursement for homebirth. Health care organizations' concerns for cost containment had little impact on this health insurance trend. Our study concludes that jurisdictional openings in the system of professions can be facilitated by a small number of strategically positioned individuals.
Collapse
Affiliation(s)
- Heather Hartley
- Department of Sociology, Portland State University, OR 97207, USA.
| | | |
Collapse
|
48
|
Janssen PA, Lee SK, Ryan ER, Saxell L. An evaluation of process and protocols for planned home birth attended by regulated midwives in British Columbia. J Midwifery Womens Health 2003; 48:138-45. [PMID: 12686947 DOI: 10.1016/s1526-9523(02)00418-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Midwifery emerged as a self-regulated profession in British Columbia in the context of a 2-year demonstration project beginning in 1998. The project evaluated accountability among midwives, defined as the provision of safe and appropriate care and maintenance of standards of communication set by the College of Midwives of British Columbia. Adherence to protocols was measured by using documentation designed specifically for the Home Birth Demonstration Project. Hospital and transport records for selected clients were reviewed by an expert committee. Outcomes among Home Birth Demonstration Project clients were compared with outcomes among women eligible for home birth but planning to deliver in hospital. Adherence to clinical and communication protocols was 96% or higher. Planned home birth was not associated with an increase in risk but prevalence of adverse outcomes was too low to be studied with precision. Recommendations of an expert review committee have been implemented or are under review. Midwives have demonstrated a high degree of compliance with reporting requirements and protocols. Comparisons of birth outcomes of planned home versus hospital births, while supporting home birth as a choice for women, were limited in scope and require ongoing study. Integration of home birth has been a dynamic process with guidelines and policy continuing to evolve.
Collapse
Affiliation(s)
- Patricia A Janssen
- Department of Health Care and Epidemiology, University of British Columbia, 5804 Fairview Avenue, Vancouver, BC, Canada V6T 1Z3
| | | | | | | |
Collapse
|
49
|
|
50
|
Outcomes of Planned Home Births in Washington State: 1989-1996. Obstet Gynecol 2003. [DOI: 10.1097/00006250-200301000-00044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
|