Women prefer hospital births

Syrian women's preferences for birth attendant and birth place

BACKGROUND

Women's preferences for type of maternity caregiver and birth place have gained importance and have been documented in studies reported from the developed world. The purpose of our study was to identify Syrian women's preferences for birth attendant and place of delivery.

METHODS

Interviews with 500 women living in Damascus and its suburbs were conducted using a pretested structured questionnaire. Women were asked about their preferences for the birth attendant and place of delivery, and an open-ended question asked them to give an explanation for their preferences. We analyzed preferences and their determinants, and also agreement between actual and preferred place of delivery and birth attendant.

RESULTS

Only a small minority of women (5-10%) had no preference. Most (65.8%) preferred to give birth at the hospital, and 60.4 percent preferred to be attended by doctors compared with midwives (21.2%). More than 85 percent of women preferred the obstetrician to be a female. The actual place of delivery and type of birth attendant did not match the preferred place of delivery and type of birth attendant. Women's reasons for preferences were a perception of safety and competence, and communication style of caregiver.

CONCLUSIONS

Most women preferred to be delivered by female doctors at a hospital in this population sample in Syria. The findings suggest that proper understanding of women's preferences is needed, and steps should be taken to enable women to make good choices. Policies about maternity education and services should take into account women's preferences.

Women's experiences of maternity care: satisfaction or passivity?

This study is a first attempt to describe Lebanese women's responses to the medical management of their pregnancy and delivery. A qualitative approach in data collection and analysis was adopted to gain an in-depth view of women's perceptions. Women of any parity undergoing a normal vaginal delivery during the three months preceding the interview were interviewed in different areas in Lebanon: one urban, one semi-rural and two remote rural. Childbirth for all the women interviewed was managed within the medical system. Findings show that women accord total trust to their physicians, and very rarely question the usefulness of many routinely applied procedures, even those which the literature shows are unnecessary. When probed, women report that many aspects of the technical care are intimidating and that they experience discomfort with these procedures. Women are more vocal about patient-provider communication and value good interaction with their provider. The extent of passivity and feelings of discontent women have varies according to their social class and the amount of psychosocial support they receive throughout the process of childbirth.

Women's views of the place of confinement

BACKGROUND

The proportion of births taking place in the home of the mother has declined to less than 1% of the total, in spite of the lack of evidence of the benefits of hospitalization. Home confinement remains rare when supported by general practitioners; little is known of the preferences of women of childbearing age.

AIMS

To examine the beliefs of women of childbearing age concerning the advantages and disadvantages of giving birth in hospital or their own homes, the choices of place of birth open to them, and the information required to enable an informed choice.

METHOD

A self-administered postal questionnaire was sent to a sample of 340 women aged 20-40 years who were registered with the study practice--a single-handed urban general practice that supports home confinement.

RESULTS

Completed questionnaires were received from 68% (241) of subjects. Parity of respondents ranged from zero (24%) to five. Altogether, 76% (159) of the respondents had previously had children. A total of 97% (154) of the parous respondents had prior experience only of delivery in hospital. In all, 86% (198) of the respondents expressed a preference for hospital delivery for any future children, with 3.5% (8) preferring home and 10.5% (24) undecided. Preference for home birth was associated with multiparity and indecision with nulliparity (Kruskal-Wallis, P = 0.040). Most women believed that giving birth in hospital was safer than at home. Most women had little knowledge of the advantages and disadvantages of giving birth at home and in hospital, although there was substantial demand for further information, and a minority who were better informed than their peers. A minority of respondents spontaneously expressed hostility to all home confinements.

CONCLUSIONS

Women show a wide spectrum of opinion on this subject. Further information is needed for women to make a free and informed choice of place of birth; providing this in an acceptable form is likely to require knowledge of the individuals concerned.

Collaborative survey of perinatal loss in planned and unplanned home births. Northern Region Perinatal Mortality Survey Coordinating Group

OBJECTIVE

To document the outcome of planned and unplanned births outside hospital.

DESIGN

Confidential review of every pregnancy ending in stillbirth or neonatal death in which plans had been made for home delivery, irrespective of where delivery eventually occurred. The review was part of a sustained collaborative survey of all perinatal deaths.

SETTING

Northern Regional Health Authority area.

SUBJECTS

All 558,691 registered births to women normally resident in the former Northern Regional Health Authority area during 1981-94.

MAIN OUTCOME MEASURE

Perinatal death.

RESULTS

The estimated perinatal mortality during 1981-94 among women booked for a home birth was 14 deaths in 2888 births. This was less than half that among all women in the region. Only three of the 14 women delivered outside hospital. Independent review suggested that two of the 14 deaths might have been averted by different management. Both births occurred in hospital, and in only one was management before admission of the mother judged inappropriate. Perinatal loss to the 64 women who booked for hospital delivery but delivered outside and to the 67 women who delivered outside hospital without ever making arrangements to receive professional care during labour accounted for the high perinatal mortality (134 deaths in 3466 deliveries) among all births outside hospital.

CONCLUSIONS

The perinatal hazard associated with planned home birth in the few women who exercised this option (< 1%) was low and mostly unavoidable. Health authorities purchasing maternity care need to address the much greater hazard associated with unplanned delivery outside hospital.

Outcome in low risk pregnancies

AIMS

To determine the obstetric and neonatal outcomes of a cohort of very low risk pregnancies in hospital, that would be suitable for home delivery.

METHODS

A retrospective analysis was undertaken of computerised records covering five years from July 1988 to August 1993 of 32424 pregnant women who delivered at the North Staffordshire Maternity Hospital, Stoke on Trent, during that period.

RESULTS

Of 32424 deliveries, only 1314 (4%) fulfilled our criteria for being low risk. Sixty seven (5.1%) of the low risk group had an operative delivery, with Caesarean section accounting for 32 (2.4%) cases, 16 (23.9%) babies were resuscitated and three were intubated. A normal vaginal delivery occurred in 1245 women, but a paediatrician attended 122 births (9.22%), assisted ventilation was provided in 65 cases (5.2%), and five babies were intubated (0.4%). Fourteen babies in total were admitted to the neonatal unit and one died.

CONCLUSIONS

These results suggest that at least 5% of women suitable for delivery at home will require transfer in labour. Midwives attending home births must be skilled in bag and mask resuscitation as only rarely will an urgent intubation be required. The British Paediatric Association Working Party report on neonatal resuscitation suggests a need for resuscitation in only 0.2% of low risk deliveries: but these findings suggest that the need is greater.