1
|
Alcaraz-Vidal L, Escuriet R, Palau-Costafreda R, Leon-Larios F, Robleda G. Midwife-attended planned home births versus planned hospital births in Spain: Maternal and neonatal outcomes. Midwifery 2024; 136:104101. [PMID: 39002394 DOI: 10.1016/j.midw.2024.104101] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2023] [Revised: 06/10/2024] [Accepted: 07/03/2024] [Indexed: 07/15/2024]
Abstract
BACKGROUND The debate on the safety and outcomes of home versus hospital births highlights the need for evidence-based evaluations of these birthing settings, particularly in Catalonia where both options are available. AIM To compare sociodemographic characteristics and maternal and neonatal outcomes between low-risk women opting for home versus hospital births in Catalonia, Spain. METHODS This observational cross-sectional study analysed 3,463 low-risk births between 2016 and 2018, including 2,713 hospital and 750 home births. Researchers collected sociodemographic data, birthing processes, and outcomes, using statistical analysis to explore differences between the settings. FINDINGS Notable differences emerged: Women choosing home births typically had higher education levels and were predominantly Spanish. They were 3.43 times more likely to have a spontaneous birth and significantly less likely to undergo instrumental births than those in hospitals. Home births were associated with higher utilization of non-pharmacological analgesia and a more pronounced tendency to iniciate breastfeeding within the first hour post birth and stronger inclination towards breastfeeding. Hospital births, conversely, showed higher use of the lithotomy position and epidural analgesia. There were no significant differences in neonatal outcomes between the two groups. CONCLUSIONS AND IMPLICATION FOR PRACTICE Home births managed by midwives offered better obstetric and neonatal outcomes for low-risk women than hospital births. These results suggest home birth as a safe, viable option that promotes natural birthing processes and reduces medical interventions. The study supports the integration of midwife-led home birth into public health policies, affirming its benefits for maternal and neonatal health.
Collapse
Affiliation(s)
- Lucia Alcaraz-Vidal
- Department of Obstetrics and Gynecology, University Hospital Germans Trias i Pujol, Badalona, Spain; Research Group on Sexual and Reproductive Healthcare (GRASSIR) (2021-SGR-01489), Barcelona 08007, Spain; Catalan Association of home birth Midwives, Barcelona, Spain; Sexual and Reproductive Healthcare, Catalan Health Institute, Spain
| | - Ramon Escuriet
- Head of the Affective, Sexual and Reproductive Health Plan of the Ministry of Health, Government of Catalonia, Spain; Global Health, Gender and Society Research Group, Facultat de Ciències de la Salut Blanquerna, Universitat Ramon Llull, Barcelona, Spain
| | - Roser Palau-Costafreda
- ESIMar (Mar Nursing School), Parc de Salut MAr, Universitat Pompeu Fabra -affilliated, Barcelona, Spain; SDHEd (Social Determinants and Health Education Research Group), IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain
| | - Fatima Leon-Larios
- Nursing Department, Faculty of Nursing, Physiotherapy and Podiatry, University of Seville, Sevilla, Spain.
| | - Gemma Robleda
- School of Medicine, Universitat de Vic- Universitat Central de Catalunya, Vic, Spain; Centro Cochrane Iberoamericano, Barcelona, Spain
| |
Collapse
|
2
|
Thomas J, Kuliukas L, Frayne J, Bradfield Z. Factors influencing referral to maternity models of care in Australian general practice. PLoS One 2024; 19:e0296537. [PMID: 38771817 PMCID: PMC11108194 DOI: 10.1371/journal.pone.0296537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 04/02/2024] [Indexed: 05/23/2024] Open
Abstract
BACKGROUND In the Australian maternity system, general practitioners play a vital role in advising and directing prospective parents to maternity models of care. Optimising model of care discussions and the decision-making process avoids misaligning women with over or under specialised care, reduces the potential for disruptive care transitions and unnecessary healthcare costs, and is critical in ensuring consumer satisfaction. Current literature overwhelmingly focusses on women's decision-making around model of care discussions and neglects the gatekeeping role of the General Practitioner (GP). This study aimed to explore and describe the factors influencing Australian GPs decision-making when referring pregnant women to maternity models of care. METHODS This study used a qualitative descriptive approach. General practitioners (N = 12) with experience referring women to maternity models of care in Australia participated in a semi-structured interview. Interviews occurred between October and November 2021 by telephone or videoconference. Reflexive thematic analysis was facilitated by NVivo-12 data management software to codify and interpret themes from the data. FINDINGS Two broad themes were interpreted from the data. The first theme entitled 'GP Factors', incorporated three associated sub-themes including '1) GPs Previous Model of Care Experience', '2) Gaps in GP Knowledge' and '3) GP Perception of Models of Care'. The second theme, entitled 'Woman's Factors', encapsulated two associated sub-themes including the '4) Woman's Preferences' and '5) Access to Models'. CONCLUSIONS This study provides novel evidence regarding general practitioner perspectives of the factors influencing model of care decision-making and referral. Predominant findings suggest that gaps in GP knowledge regarding the available models of care are present and are largely informed by prior personal and professional experience. Most GPs described referring to models of care they perceive positively and centring their model of care discussions on the woman's preferences and accessibility. The exploration and description of factors influencing model of care decisions provide unique insight into the ways that all stakeholders can experience access to a broader range of models of care including midwifery-led continuity of care models aligned with consumer-demand. In addition, the role of national primary health networks is outlined as a means to achieving this.
Collapse
Affiliation(s)
- Jaime Thomas
- School of Nursing, Curtin University, Bentley, Western Australia, Australia
| | - Lesley Kuliukas
- School of Nursing, Curtin University, Bentley, Western Australia, Australia
| | - Jacqueline Frayne
- Medical School, University of Western Australia, Albany, Western Australia, Australia
| | - Zoe Bradfield
- School of Nursing, Curtin University, Bentley, Western Australia, Australia
| |
Collapse
|
3
|
Hu Y, Allen J, Ellwood D, Slavin V, Gamble J, Toohill J, Callander E. The financial impact of offering publicly funded homebirths: A population-based microsimulation in Queensland, Australia. Women Birth 2024; 37:137-143. [PMID: 37524616 DOI: 10.1016/j.wombi.2023.07.129] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2023] [Revised: 07/17/2023] [Accepted: 07/19/2023] [Indexed: 08/02/2023]
Abstract
BACKGROUND Despite strong evidence of benefits and increasing consumer demand for homebirth, Australia has failed to effectively upscale it. To promote the adoption and expansion of homebirth in the public health care system, policymakers require quantifiable results to evaluate its economic value. To date, there has been limited evaluation of the financial impact of birth settings for women at low risk of pregnancy complications. OBJECTIVE This study aimed to examine the difference in inpatient costs around birth between offering homebirth in the public maternity system versus not offering public homebirth to selected women who meet low-risk pregnancy criteria. METHODS We used a whole-of-population linked administrative dataset containing all women who gave birth in Queensland (one Australian State) between 01/07/2012 and 30/06/2018 where publicly funded homebirth is not currently offered. We created a static microsimulation model to compare the inpatient cost difference for mother and baby around birth based on the women who gave birth between 01/07/2017 and 30/06/2018 (n = 36,314). The model comprised of a base model - representing standard public hospital care, and a counterfactual model - representing a hypothetical scenario where 5 % of women who gave birth in public hospitals planned to give birth at home prior to the onset of labour (n = 1816). Costs were reported in 2021/22 AUD. RESULTS In our hypothetical scenario, after considering the effect of assumptive place and mode of birth for these planned homebirths, the estimated State-level inpatient cost saving around birth (summed for mother and babies) per pregnancy were: AU$303.13 (to Queensland public hospitals) and AU$186.94 (to Queensland public hospital funders). This calculates to a total cost saving per annum of AU$11 million (to Queensland public hospitals) and AU$6.8 million (to Queensland public hospital funders). CONCLUSION A considerable amount of inpatient health care costs around birth could be saved if 5 % of women booked at their local public hospitals, planned to give birth at home through a public-funded homebirth program. This finding supports the establishment and expansion of the homebirth option in the public health care system.
Collapse
Affiliation(s)
- Yanan Hu
- Monash Centre for Health Research and Implementation, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia
| | - Jyai Allen
- Monash Centre for Health Research and Implementation, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia; Molly Wardaguga Research Centre, Charles Darwin University, Brisbane, Australia
| | - David Ellwood
- School of Medicine & Dentistry, Griffith University, Gold Coast, Australia; Gold Coast University Hospital, Gold Coast Hospital and Health Service, Southport, Australia
| | - Valerie Slavin
- Monash Centre for Health Research and Implementation, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia; Gold Coast University Hospital, Gold Coast Hospital and Health Service, Southport, Australia; School of Nursing and Midwifery, Griffith University, Gold Coast, Australia
| | - Jenny Gamble
- School of Nursing and Midwifery, Griffith University, Gold Coast, Australia; School of Nursing, Midwifery and Health, Coventry University, Coventry, United Kingdom
| | - Jocelyn Toohill
- School of Nursing, Midwifery and Health, Coventry University, Coventry, United Kingdom; Clinical Excellence Division, Queensland Health, Queensland, Australia
| | - Emily Callander
- Monash Centre for Health Research and Implementation, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Australia.
| |
Collapse
|
4
|
Bazirete O, Hughes K, Lopes SC, Turkmani S, Abdullah AS, Ayaz T, Clow SE, Epuitai J, Halim A, Khawaja Z, Mbalinda SN, Minnie K, Nabirye RC, Naveed R, Nawagi F, Rahman F, Rasheed SI, Rehman H, Nove A, Forrester M, Mandke S, Pairman S, Homer CSE. Midwife-led birthing centres in four countries: a case study. BMC Health Serv Res 2023; 23:1105. [PMID: 37848936 PMCID: PMC10583445 DOI: 10.1186/s12913-023-10125-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 10/06/2023] [Indexed: 10/19/2023] Open
Abstract
BACKGROUND Midwives are essential providers of primary health care and can play a major role in the provision of health care that can save lives and improve sexual, reproductive, maternal, newborn and adolescent health outcomes. One way for midwives to deliver care is through midwife-led birth centres (MLBCs). Most of the evidence on MLBCs is from high-income countries but the opportunity for impact of MLBCs in low- and middle-income countries (LMICs) could be significant as this is where most maternal and newborn deaths occur. The aim of this study is to explore MLBCs in four low-to-middle income countries, specifically to understand what is needed for a successful MLBC. METHODS A descriptive case study design was employed in 4 sites in each of four countries: Bangladesh, Pakistan, South Africa and Uganda. We used an Appreciative Inquiry approach, informed by a network of care framework. Key informant interviews were conducted with 77 MLBC clients and 33 health service leaders and senior policymakers. Fifteen focus group discussions were used to collect data from 100 midwives and other MLBC staff. RESULTS Key enablers to a successful MLBC were: (i) having an effective financing model (ii) providing quality midwifery care that is recognised by the community (iii) having interdisciplinary and interfacility collaboration, coordination and functional referral systems, and (iv) ensuring supportive and enabling leadership and governance at all levels. CONCLUSION The findings of this study have significant implications for improving maternal and neonatal health outcomes, strengthening healthcare systems, and promoting the role of midwives in LMICs. Understanding factors for success can contribute to inform policies and decision making as well as design tailored maternal and newborn health programmes that can more effectively support midwives and respond to population needs. At an international level, it can contribute to shape guidelines and strengthen the midwifery profession in different settings.
Collapse
Affiliation(s)
- Oliva Bazirete
- College of Medicine and Health, Sciences, University of Rwanda, Kigali, Rwanda.
- Novametrics Ltd, Duffield, UK.
| | | | | | | | - Abu Sayeed Abdullah
- Centre for Injury Prevention and Research, Bangladesh (CIPRB), Dhaka, Bangladesh
| | | | | | | | - Abdul Halim
- Centre for Injury Prevention and Research, Bangladesh (CIPRB), Dhaka, Bangladesh
| | | | | | - Karin Minnie
- University of the Western Cape, Cape Town, South Africa
| | | | - Razia Naveed
- Research & Development Solutions, Islamabad, Pakistan
| | | | - Fazlur Rahman
- Centre for Injury Prevention and Research, Bangladesh (CIPRB), Dhaka, Bangladesh
| | | | - Hania Rehman
- Research & Development Solutions, Islamabad, Pakistan
| | | | - Mandy Forrester
- International Confederation of Midwives, The Hague, Netherlands
| | - Shree Mandke
- International Confederation of Midwives, The Hague, Netherlands
| | - Sally Pairman
- International Confederation of Midwives, The Hague, Netherlands
| | | |
Collapse
|
5
|
Gillen P, Bamidele O, Healy M. Systematic review of women's experiences of planning home birth in consultation with maternity care providers in middle to high-income countries. Midwifery 2023; 124:103733. [PMID: 37307778 DOI: 10.1016/j.midw.2023.103733] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 05/04/2023] [Accepted: 05/18/2023] [Indexed: 06/14/2023]
Abstract
AIM To synthesise findings from published studies, which reported on women's experiences of planning a home birth in consultation with maternity care providers. DESIGN Systematic Review DATA SOURCES: We searched seven bibliographic databases, (Ovid Medline, Embase, PsycInfo, CINAHL plus, Scopus, ProQuest and Cochrane (Central and Library), from January 2015 to 29th April 2022. REVIEW METHODS Primary studies were included if they investigated women's experiences of planning a home birth with maternity care providers, in upper-middle and high-income countries and written in English language. Studies were analysed using thematic synthesis. GRADE-CERQual was used to assess the quality, coherence, adequacy and relevance of data. The protocol is registered on PROSPERO registration ID: CRD 42018095042 (updated 28th September 2020) and published. RESULTS 1274 articles were retrieved, and 410 duplicates removed. Following screening and quality appraisal, 20 eligible studies (19 qualitative and 1 survey) involving 2,145 women were included. KEY CONCLUSIONS Women's prior traumatic experience of hospital birth and a preference for physiological birth motivated their assertive decision to have a planned home birth despite criticisms and stigmatisation from their social circle and some maternity care providers. Midwives' competence and support enhanced women's confidence and positive experiences of planning a home birth. IMPLICATIONS FOR PRACTICE This review highlights the stigma that some women feel and the importance of support from health professionals, particularly midwives when planning a home birth. We recommend accessible evidence-based information for women and their families to support women's decision-making for planned home birth. The findings from this review can be used to inform woman-centred planned home birth services, particularly in the UK, (although evidence is drawn from papers in eight other countries, so findings are relevant elsewhere), which will impact positively on the experiences of women who are planning home birth.
Collapse
Affiliation(s)
- Patricia Gillen
- Southern Health and Social Care Trust, 10 Moyallen Road, Gilford, Co Down, Northern Ireland, UK; Institute of Nursing and Health Research, Ulster University, Shore Road, Newtownabbey, BT37 0QB, Northern Ireland, UK.
| | - Olufikayo Bamidele
- Institute of Nursing and Health Research, Ulster University, Shore Road, Newtownabbey, BT37 0QB, Northern Ireland, UK; School of Nursing and Midwifery, Queen's University Belfast BT9 7BL, Northern Ireland, UK; Institute for Clinical and Applied Health Research, Hull York Medical School, University of Hull, HU6 7RX, UK.
| | - Maria Healy
- School of Nursing and Midwifery, Queen's University Belfast BT9 7BL, Northern Ireland, UK.
| |
Collapse
|
6
|
Nove A, Bazirete O, Hughes K, Turkmani S, Callander E, Scarf V, Forrester M, Mandke S, Pairman S, Homer CS. Which low- and middle-income countries have midwife-led birthing centres and what are the main characteristics of these centres? A scoping review and scoping survey. Midwifery 2023; 123:103717. [PMID: 37182478 PMCID: PMC10281083 DOI: 10.1016/j.midw.2023.103717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 04/22/2023] [Accepted: 05/07/2023] [Indexed: 05/16/2023]
Abstract
Evidence about the safety and benefits of midwife-led care during childbirth has led to midwife-led settings being recommended for women with uncomplicated pregnancies. However, most of the research on this topic comes from high-income countries. Relatively little is known about the availability and characteristics of midwife-led birthing centres in low- and middle-income countries (LMICs). This study aimed to identify which LMICs have midwife-led birthing centres, and their main characteristics. The study was conducted in two parts: a scoping review of peer-reviewed and grey literature, and a scoping survey of professional midwives' associations and United Nations Population Fund country offices. We used nine academic databases and the Google search engine, to locate literature describing birthing centres in LMICs in which midwives or nurse-midwives were the lead care providers. The review included 101 items published between January 2012 and February 2022. The survey consisted of a structured online questionnaire, and responses were received from 77 of the world's 137 low- and middle-income countries. We found at least one piece of evidence indicating that midwife-led birthing centres existed in 57 low- and middle-income countries. The evidence was relatively strong for 24 of these countries, i.e. there was evidence from at least two of the three types of source (peer-reviewed literature, grey literature, and survey). Only 14 of them featured in the peer-reviewed literature. Low- and lower-middle-income countries were more likely than upper-middle-income countries to have midwife-led birthing centres. The most common type of midwife-led birthing centre was freestanding. Public-sector midwife-led birthing centres were more common in middle-income than in low-income countries. Some were staffed entirely by midwives and some by a multidisciplinary team. We identified challenges to the midwifery philosophy of care and to effective referral systems. The peer-reviewed literature does not provide a comprehensive picture of the locations and characteristics of midwife-led birthing centres in low- and middle-income countries. Many of our findings echo those from high-income countries, but some appear to be specific to some or all low- and middle-income countries. The study highlights knowledge gaps, including a lack of evidence about the impact and costs of midwife-led birthing centres in low- and middle-income countries.
Collapse
Affiliation(s)
| | - Oliva Bazirete
- Novametrics Ltd, Duffield, Derbyshire, UK; University of Rwanda School of Nursing and Midwifery, Kigali, Rwanda
| | | | - Sabera Turkmani
- Burnet Institute Global Women's and Newborn Health Group, Melbourne, Vic, Australia
| | - Emily Callander
- Monash University Health Systems Services & Policy Unit, Melbourne, Vic, Australia
| | - Vanessa Scarf
- University of Technology Sydney School of Nursing and Midwifery, Sydney, NSW, Australia
| | - Mandy Forrester
- International Confederation of Midwives, The Hague, The Netherlands
| | - Shree Mandke
- International Confederation of Midwives, The Hague, The Netherlands
| | - Sally Pairman
- International Confederation of Midwives, The Hague, The Netherlands
| | - Caroline Se Homer
- Burnet Institute Global Women's and Newborn Health Group, Melbourne, Vic, Australia; University of Technology Sydney School of Nursing and Midwifery, Sydney, NSW, Australia
| |
Collapse
|
7
|
Sands G, Evans K, Spiby H, Eldridge J, Pallotti P, Evans C. Birth environments for women with complex pregnancies: A mixed-methods systematic review. Women Birth 2023; 36:39-46. [PMID: 35431173 DOI: 10.1016/j.wombi.2022.04.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 04/04/2022] [Accepted: 04/08/2022] [Indexed: 01/28/2023]
Abstract
BACKGROUND Birth environments can help support women through labour and birth. Home-like rooms which encourage active birthing are embraced in midwifery-led settings. However, this is often not reflected in obstetric settings for women with more complex pregnancies. AIM To investigate the impact of the birth environment for women with complex pregnancies. METHODS This was a mixed-methods systematic review, incorporating qualitative and quantitative research. A literature search was implemented across three databases (Medline, CINAHL, Embase) from the year 2000 to June 2021. Studies were eligible if they were based in an Organisation for Economic Cooperation and Development country and reported on birth environments for women with complex pregnancies. Papers were screened and quality appraised by two researchers independently. FINDINGS 30,345 records were returned, with 15 articles meeting inclusion criteria. Studies were based in Australia, the UK, and the USA. Participants included women and health professionals. Five main themes arose: Quality of care and experience; Supportive spaces for women; Supportive spaces for midwives; Control of the space; Design issues. DISCUSSION Women and midwives found the birth environment important in supporting, or failing to support, a positive birth experience. Obstetric environments are complex spaces requiring balance between space for women to mobilise and access birthing aids, with the need for medical teams to have easy access to the woman and equipment in emergencies. CONCLUSION Further research is needed investigating different users' needs from the environment and how safety features can be balanced with comfort to provide high-quality care and positive experiences for women.
Collapse
Affiliation(s)
- Gina Sands
- School of Health Sciences, B Floor, University of Nottingham, Queen's Medical Centre, Nottingham NG7 2UH, UK.
| | - Kerry Evans
- School of Health Sciences, B Floor, University of Nottingham, Queen's Medical Centre, Nottingham NG7 2UH, UK
| | - Helen Spiby
- School of Health Sciences, B Floor, University of Nottingham, Queen's Medical Centre, Nottingham NG7 2UH, UK
| | - Jeanette Eldridge
- School of Health Sciences, B Floor, University of Nottingham, Queen's Medical Centre, Nottingham NG7 2UH, UK
| | - Phoebe Pallotti
- School of Health Sciences, B Floor, University of Nottingham, Queen's Medical Centre, Nottingham NG7 2UH, UK
| | - Catrin Evans
- School of Health Sciences, B Floor, University of Nottingham, Queen's Medical Centre, Nottingham NG7 2UH, UK
| |
Collapse
|
8
|
Coddington R, Fox D, Scarf V, Catling C. Getting kicked off the program: Women's experiences of antenatal exclusion from publicly-funded homebirth in Australia. Women Birth 2023; 36:e179-e185. [PMID: 35764492 DOI: 10.1016/j.wombi.2022.06.008] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2021] [Revised: 06/09/2022] [Accepted: 06/20/2022] [Indexed: 01/25/2023]
Abstract
PROBLEM Eligibility criteria for publicly-funded homebirth models are strict and, as such, many women who initially plan a homebirth later become excluded. BACKGROUND Fifteen publicly-funded homebirth programs are operating in Australia, offering eligible women the opportunity to give birth at home at no cost, with the care of a hospital-employed midwife. AIM To explore the experiences of women who planned a publicly-funded homebirth and were later excluded due to pregnancy complications or risk factors. METHODS A qualitative descriptive approach was taken. Recruitment was via social media sites specifically related to homebirth in Australia. Data collection involved semi-structured telephone interviews. Transcripts were thematically analysed. FINDINGS Thirteen women participated. They were anxious about 'Jumping through hoops' to maintain their low-risk status. After being 'Kicked off the program', women carefully 'negotiated the system' in order to get the birth they wanted in hospital. Some women felt bullied and coerced into complying with hospital protocols that did not account for their individual needs. Maintaining the midwife-woman relationship was a protective factor, decreasing negative experiences. DISCUSSION Women plan a homebirth to avoid the medicalised hospital environment and to gain access to continuity of midwifery care. To provide maternity care that is acceptable to women, hospital institutions need to design services that enable continuity of the midwife-woman relationship and assess risk on an individual basis. CONCLUSION Exclusion from publicly-funded homebirth has the potential to negatively impact women who may feel a sense of loss, uncertainty or emotional distress related to their planned place of birth.
Collapse
Affiliation(s)
- Rebecca Coddington
- Centre for Midwifery, Child and Family Health, University of Technology Sydney, Australia.
| | - Deborah Fox
- Centre for Midwifery, Child and Family Health, University of Technology Sydney, Australia. https://twitter.com/@debjfox
| | - Vanessa Scarf
- Centre for Midwifery, Child and Family Health, University of Technology Sydney, Australia. https://twitter.com/@VScarf
| | - Christine Catling
- Centre for Midwifery, Child and Family Health, University of Technology Sydney, Australia. https://twitter.com/@ChristineCatli1
| |
Collapse
|
9
|
Batinelli L, McCourt C, Bonciani M, Rocca-Ihenacho L. Implementing midwifery units in a European country: Situational analysis of an Italian case study. Midwifery 2023; 116:103534. [PMID: 36395602 DOI: 10.1016/j.midw.2022.103534] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2022] [Revised: 10/06/2022] [Accepted: 10/28/2022] [Indexed: 11/07/2022]
Abstract
INTRODUCTION Strong evidence recommends midwifery-led care for women with uncomplicated pregnancies. International research is now focusing on how to implement midwifery models of care in countries where they are not well established. In Europe, many countries like Italy are promoting midwifery-led care in national guidelines but often struggle to apply this change in practice. METHODS This study collected data on professional, organisational and service users' levels to conduct a situational analysis of an Italian service which is approaching the implementation of a midwifery unit. Participatory Action Research was used together with the support of the Consolidated Framework for Implementation Research to conduct data collection and analysis. RESULTS Forty-eight participants amongst professionals (midwives, obstetricians and neonatologists) and at organisational level (midwifery leaders and medical directors) were recruited; secondary data on service users' views was analysed via regional online surveys. Barriers and facilitators to the implementation were identified to assess the readiness of the local context. CONCLUSIONS This study is the first to include professionals, managers and service users in a European context such as Italy. Facilitators to the implementation of the alongside midwifery unit were found in national guidelines, allocated funding, collaborative engagement and medical support. Hierarchical structures, a prevalent medical model and lack of trust and awareness of the evidence of safety of midwifery-led models were main barriers.
Collapse
Affiliation(s)
- Laura Batinelli
- Centre for Maternal and Child Health Research, School of Health and Psychological Sciences, City, University of London, 1 Myddelton Street, London EC1R 1UW, UK.
| | - Christine McCourt
- Centre for Maternal and Child Health Research, School of Health and Psychological Sciences, City, University of London, 1 Myddelton Street, London EC1R 1UW, UK
| | - Manila Bonciani
- Laboratorio Management e Sanità, Institute of Management, Scuola Superiore Sant'Anna, Piazza Martiri della Libertà, 33, CAP 56127 Pisa, Italy
| | - Lucia Rocca-Ihenacho
- Centre for Maternal and Child Health Research, School of Health and Psychological Sciences, City, University of London, 1 Myddelton Street, London EC1R 1UW, UK
| |
Collapse
|
10
|
Pramono A, Smith J, Bourke S, Desborough J. "We All Believe in Breastfeeding": Australian Midwives' Experience of Implementing the Baby Friendly Hospital Initiative. J Hum Lact 2022; 38:780-791. [PMID: 35792378 DOI: 10.1177/08903344221106473] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND The education and support of new mothers during the in-hospital stay for childbirth is a critical time to establish breastfeeding. The Baby-Friendly Hospital Initiative was launched in 1991 to encourage maternity services to support and educate mothers to breastfeed by implementing Ten Steps to Successful Breastfeeding. RESEARCH AIM To explore midwives' experiences of implementing the Baby-Friendly Hospital Initiative in a Baby-Friendly accredited public hospital in Australia. METHODS In this prospective, cross-sectional qualitative study we used focus groups to explore midwives' experiences. Midwives (N = 26) participated in two focus groups conducted between October and November 2019. Data were analyzed using thematic analysis. RESULTS Time as a critical resource, and continuity of care, were crosscutting themes that framed midwives' experiences in supporting mothers to breastfeed their babies. Time constraints were experienced both through the health system structure and the BFHI accreditation process. Despite the challenges, the overarching theme-that we all believe in breastfeeding-fueled midwives' motivation. CONCLUSION Health services policy and practice need to consider ways to enable continuity of midwifery care and adequate time for midwives to support women to breastfeed their babies.
Collapse
Affiliation(s)
- Andini Pramono
- Department of Health Services Research and Policy, National Centre for Epidemiology and Population Health, Australian National University, Canberra, ACT, Australia
| | - Julie Smith
- Department of Health Services Research and Policy, National Centre for Epidemiology and Population Health, Australian National University, Canberra, ACT, Australia
| | - Siobhan Bourke
- Department of Health Services Research and Policy, National Centre for Epidemiology and Population Health, Australian National University, Canberra, ACT, Australia
| | - Jane Desborough
- Department of Health Services Research and Policy, National Centre for Epidemiology and Population Health, Australian National University, Canberra, ACT, Australia
| |
Collapse
|
11
|
Gerzen L, Tietjen SL, Heep A, Puth MT, Schmid M, Gembruch U, Merz WM. Why are women deciding against birth in alongside midwifery units? A prospective single-center study from Germany. J Perinat Med 2022; 50:1124-1134. [PMID: 35611852 DOI: 10.1515/jpm-2022-0041] [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] [Received: 01/27/2022] [Accepted: 04/24/2022] [Indexed: 11/15/2022]
Abstract
OBJECTIVES For healthy women entering labor after an uneventful pregnancy, advantages of birth in midwife-led models of care have been demonstrated. We aimed to study the level of awareness regarding care in alongside midwifery units (AMU), factors involved in the decision for birth in obstetrician-led units (OLU), and wishes for care and concerns about birth in women registering for birth in OLU who would have been eligible for care in AMU. METHODS Healthy women with a term singleton cephalic fetus after an uneventful pregnancy course booking for birth in OLU were prospectively recruited. Data were collected by questionnaire. RESULTS In total, 324 questionnaires were analyzed. One quarter (23.1%) of participants never had heard of care in AMU. Two thirds (64.2%) of women had made their choice regarding model of care before entering late pregnancy; only 16.4% indicated that health professionals had the biggest impact on their decision. One-to-one care and the availability of a pediatrician were most commonly quoted wishes (30.8 and 34.0%, respectively), and the occurrence of an adverse maternal or perinatal event the greatest concern (69.5%). CONCLUSIONS Although the majority of respondents had some knowledge about care in AMU, expressed wishes for birth matching core features of AMU and concerns matching those of OLU, a decision for birth in OLU was taken. This finding may be a result of lack of knowledge about details of care in AMU; additionally, wishes and concerns may be put aside in favor of other criteria.
Collapse
Affiliation(s)
| | | | - Andrea Heep
- Department of Obstetrics and Prenatal Medicine, University Hospital Bonn, Bonn, Germany
| | - Marie-Therese Puth
- Department of Medical Biometry, Informatics and Epidemiology, Faculty of Medicine, University of Bonn, Bonn, Germany
| | - Matthias Schmid
- Department of Medical Biometry, Informatics and Epidemiology, Faculty of Medicine, University of Bonn, Bonn, Germany
| | - Ulrich Gembruch
- Department of Obstetrics and Prenatal Medicine, University Hospital Bonn, Bonn, Germany
| | - Waltraut M Merz
- Department of Obstetrics and Prenatal Medicine, University Hospital Bonn, Bonn, Germany
| |
Collapse
|
12
|
Sweet L, Wynter K, O'Driscoll K, Blums T, Nenke A, Sommeling M, Kolar R, Teale G. Ten years of a publicly funded homebirth service in Victoria: Maternal and neonatal outcomes. Aust N Z J Obstet Gynaecol 2022; 62:664-673. [PMID: 35318640 PMCID: PMC9790430 DOI: 10.1111/ajo.13518] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 03/05/2022] [Indexed: 12/30/2022]
Abstract
BACKGROUND Rates of homebirth in Australia remain low, at less than 0.3% of all births. AIMS To report maternal and neonatal outcomes of ten years of a publicly funded homebirth service, 2009-2019. METHOD Retrospective analysis of clinical outcome data including neonatal outcomes of women who requested a homebirth at a large metropolitan health service in Victoria, Australia. The primary outcomes included: maternal outcomes (mortality, transfer to hospital, place and mode of birth, perineal status, type of third stage of labour, postpartum haemorrhage), and neonatal outcomes (mortality, Apgar score at five minutes, birthweight, breastfeeding initiation, significant morbidity, transfer to hospital). RESULTS Referrals for 827 women were reviewed; 633 remained eligible at 36 weeks gestation, and 473 (57%) birthed at home. Compared to women who did not, women who had a homebirth were significantly more likely to be multiparous, have a normal vaginal birth and an intact perineum, less likely to require suturing and less likely to have blood loss of more than 500 mL. Compared to infants not born at home, infants born at home were significantly less likely to require resuscitation, more likely to be of normal birthweight and exclusively receive breastmilk on discharge. There were no maternal deaths and one neonatal death of a baby born at home before the arrival of a midwife. CONCLUSIONS The outcomes for women accepted into the publicly funded homebirth program suggest appropriate triaging and case selection. A publicly funded homebirth program, with appropriate governance and clinical guidelines, appears to be a safe option for women experiencing low-risk pregnancies.
Collapse
Affiliation(s)
- Linda Sweet
- School of Nursing and MidwiferyDeakin UniversityMelbourneVictoriaAustralia,Centre for Quality and Patient Safety ResearchWestern Health PartnershipMelbourneVictoriaAustralia
| | - Karen Wynter
- School of Nursing and MidwiferyDeakin UniversityMelbourneVictoriaAustralia,Centre for Quality and Patient Safety ResearchWestern Health PartnershipMelbourneVictoriaAustralia
| | | | - Tija Blums
- Western HealthMelbourneVictoriaAustralia
| | - Agia Nenke
- Western HealthMelbourneVictoriaAustralia
| | | | | | - Glyn Teale
- Western HealthMelbourneVictoriaAustralia
| |
Collapse
|
13
|
Newnham E, Rothman BK. The quantification of midwifery research: Limiting midwifery knowledge. Birth 2022; 49:175-178. [PMID: 35285077 PMCID: PMC9315019 DOI: 10.1111/birt.12615] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2021] [Revised: 12/21/2021] [Accepted: 01/24/2022] [Indexed: 11/28/2022]
Abstract
As two academics researching in the area of maternal health, we are increasingly concerned with what we see as a positivist turn in midwifery research. In this paper, we examine this idea of the quantification of midwifery research, using as an example the current esteem given to the systematic literature review, and its creep into other methodologies. We argue that the current favor toward quantitative research and expertise in midwifery academia risks the future of midwifery research by the lack of equal development of qualitative experts, diluting qualitative research rigor within the profession, and limiting the kinds of questions asked. We identify the similarity between the current prominence of quantitative research and medical dominance in midwifery and maintain that it is of vital importance to the profession (research and practice) that the proper attention, contemplation, and merit are given to qualitative research methods.
Collapse
Affiliation(s)
- Elizabeth Newnham
- Griffith UniversityBrisbaneQueenslandAustralia,University of NewcastleNew South WalesNew South WalesAustralia
| | | |
Collapse
|
14
|
Applebaum J. Expanding certified professional midwife services during the COVID-19 pandemic. Birth 2022; 49:360-363. [PMID: 35429017 PMCID: PMC9111869 DOI: 10.1111/birt.12643] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2020] [Revised: 04/05/2022] [Accepted: 04/08/2022] [Indexed: 12/03/2022]
Abstract
Given concerns of coronavirus disease 2019 (COVID-19) acquisition in health care settings and hospital policies reducing visitors for laboring patients, many pregnant women are increasingly considering planned home births. Several state legislatures are considering increasing access to home births by granting licensure and Medicaid coverage of certified professional midwife (CPM) services. In this commentary, issues surrounding the expansion of CPM services including safety, standardization of care, patient satisfaction, racial and income equity, and an overburdened health care system are discussed. Lawmakers must account for these factors when considering proposals to expand CPM practice and payment during a pandemic.
Collapse
Affiliation(s)
- Jeremy Applebaum
- Department of Obstetrics and GynecologyHospital of the University of PennsylvaniaPhiladelphiaPennsylvaniaUSA
| |
Collapse
|
15
|
Tietjen SL, Schmitz MT, Heep A, Kocks A, Gerzen L, Schmid M, Gembruch U, Merz WM. Model of care and chance of spontaneous vaginal birth: a prospective, multicenter matched-pair analysis from North Rhine-Westphalia. BMC Pregnancy Childbirth 2021; 21:849. [PMID: 34969368 PMCID: PMC8719397 DOI: 10.1186/s12884-021-04323-1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/18/2021] [Accepted: 12/07/2021] [Indexed: 11/17/2022] Open
Abstract
Background Advantages of midwife-led models of care have been reported; these include a higher vaginal birth rate and less interventions. In Germany, 98.4% of women are giving birth in obstetrician-led units. We compared the outcome of birth planned in alongside midwifery units (AMU) with a matched group of low-risk women who gave birth in obstetrician-led units. Methods A prospective, controlled, multicenter study was conducted. Six of seven AMUs in North Rhine-Westphalia participated. Healthy women with a singleton term cephalic pregnancy booking for birth in AMU were eligible. For each woman in the study group a control was chosen who would have been eligible for birth in AMU but was booking for obstetrician-led care; matching for parity was performed. Mode of birth was chosen as primary outcome parameter. Secondary endpoints included a composite outcome of adverse outcome in the third stage and / or postpartum hemorrhage; higher-order obstetric lacerations; and for the neonate, a composite outcome (5-min Apgar < 7 and / or umbilical cord arterial pH < 7.10 and / or transfer to specialist neonatal care). Statistical analysis was by intention to treat. A non-inferiority analysis was performed. Results Five hundred eighty-nine case-control pairs were recruited, final analysis was performed with 391 case-control pairs. Nulliparous women constituted 56.0% of cases. For the primary endpoint vaginal birth superiority was established for the study group (5.66%, 95%-CI 0.42% – 10.88%). For the composite newborn outcome (1.28%, 95%-CI -1.86% - -4.47%) and for higher-order obstetric lacerations (2.33%, 95%-CI -0.45% - 5.37%) non-inferiority was established. Non-inferiority was not present for the composite maternal outcome (-1.56%, 95%-CI -6.69% - 3.57%). The epidural anesthesia rate was lower (22.9% vs. 41.1%), and the length of hospital stay was shorter in the study group (p < 0.001 for both). Transfer to obstetrician-led care occurred in 51.2% of cases, with a strong association to parity (p < 0.001). Request for regional anesthesia was the most common cause for transfer (47.1%). Conclusion Our comparison between care in AMU and obstetrician-led care with respect to mode of birth and other outcomes confirmed the superiority of this model of care for low-risk women. This pertains to AMU where admission and transfer criteria are in place and adhered to.
Collapse
Affiliation(s)
- Sophia L Tietjen
- Department of Obstetrics and Prenatal Medicine, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany.
| | - Marie-Therese Schmitz
- Department of Medical Biometry, Informatics and Epidemiology, Faculty of Medicine, University of Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Andrea Heep
- Department of Obstetrics and Prenatal Medicine, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Andreas Kocks
- Directorate of Nursing, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Lydia Gerzen
- Department of Obstetrics and Prenatal Medicine, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Matthias Schmid
- Department of Medical Biometry, Informatics and Epidemiology, Faculty of Medicine, University of Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Ulrich Gembruch
- Department of Obstetrics and Prenatal Medicine, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Waltraut M Merz
- Department of Obstetrics and Prenatal Medicine, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| |
Collapse
|
16
|
Lukač A, Šulović N, Ilić A, Mijović M, Tasić D, Smiljić S. Optimal outcome factors in maternity and newborn care for inpatient (hospital maternity ward-HMW) and outpatient deliveries (outhospital maternity clinics -OMC). BMC Pregnancy Childbirth 2021; 21:836. [PMID: 34930167 PMCID: PMC8690516 DOI: 10.1186/s12884-021-04319-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2021] [Accepted: 11/29/2021] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND AND OBJECTIVES The aim of the study was to use the United States Optimality Index (OI-US) to assess the feasibility of its application in making decisions for more optimal methods of delivery and for more optimal postpartum and neonatal outcomes. Numerous worldwide associations support the option of women giving birth at maternity outpatient clinics and also at home. What ought to be met is the assessments of requirements and what could be characterized as the birth potential constitute the basis for making the right decision regarding childbirth. MATERIALS AND METHODS The study is based on a prospective follow-up of pregnant women and new mothers (100 participants) who were monitored and gave birth at the hospital maternity ward (HMW) and pregnant women and new mothers (100 participants) who were monitored and gave birth at the outhospital maternity clinics (OMC). Selected patients were classified according to the criteria of low and medium-risk and each of the parameters of the OI and the total OI were compared. RESULTS The results of this study confirm the benefits of intrapartum and neonatal outcome, when delivery was carried out in an outpatient setting. The median OI of intrapartum components was significantly higher in the outpatient setting compared to the hospital maternity ward (97 range from 24 to 100 vs 91 range from 3 to 100). The median OI of neonatal components was significantly higher in the outpatient compared to the inpatient delivery. (99 range from 97 to 100 vs 96 range from 74 to 100). Certain components from the intrapartum and neonatal period highly contribute to the significantly better total OI in the outpatient conditions in relation to hospital conditions. CONCLUSION Outpatient care and delivery provide multiple benefits for both the mother and the newborn.
Collapse
Affiliation(s)
- Azra Lukač
- Community Health Center, Rožaje, Montenegro.
| | - Nenad Šulović
- Department of Gynecology and Obstetrics, Faculty of Medicine, University in Priština, Kosovska Mitrovica, Serbia
| | - Aleksandra Ilić
- Institute of Preventive Medicine, Faculty of Medicine, University in Priština, Kosovska Mitrovica, Serbia
| | - Milica Mijović
- Institute of Pathology, Faculty of Medicine, University in Priština, Kosovska Mitrovica, Serbia
| | - Dijana Tasić
- Clinic of Gynecology and Obstetrics "Narodni Front", Belgrade, Serbia
| | - Sonja Smiljić
- Institute of Physiology, Faculty of Medicine, University in Priština, Kosovska Mitrovica, Serbia
| |
Collapse
|
17
|
Blums T, Donnellan-Fernandez R, Sweet L. Women's perceptions of inclusion and exclusion criteria for publicly-funded homebirth - A survey. Women Birth 2021; 35:413-422. [PMID: 34518118 DOI: 10.1016/j.wombi.2021.08.007] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2021] [Revised: 08/13/2021] [Accepted: 08/19/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND There are 15 publicly-funded homebirth programs in Australia. Women's access to these programs is determined by program specific inclusion and exclusion criteria. AIMS To examine women's perception of inclusion and exclusion criteria for publicly-funded homebirth programs in Australia and how these perceptions may influence women's choices and access to these programs. METHODS A national online survey was conducted and promoted through social media networks to women interested in homebirth in Australia. Quantitative data were analysed to generate descriptive statistics and a content analysis was performed on qualitative data. FINDINGS A total of 830 surveys were collected. Most women were supportive of inclusion and exclusion criteria related to social and environmental factors, although there was ambivalence about requiring ambulance cover, not having a history of domestic violence in the current relationship and requiring the woman to speak basic English. With regards to obstetric factors, only a requirement for labour to commence spontaneously at term was supported by over half of participants. All other obstetric related criteria had over half of participants disagreeing or strongly disagreeing that they should be used to prevent a woman from birthing at home. A desire for choice and access was frequently mentioned in the qualitative data. CONCLUSION There is a need to address the lack of choice many women experience when pregnant and the lack of equitable access to affordable homebirth services in Australia.
Collapse
Affiliation(s)
- Tija Blums
- School of Nursing and Midwifery, Griffith University, Australia; Western Health, St Albans, VIC, Australia.
| | - Roslyn Donnellan-Fernandez
- School of Nursing and Midwifery, Griffith University, Australia; Transforming Maternity Care Collaborative, Australia. https://twitter.com/@RozDFernandez
| | - Linda Sweet
- Western Health, St Albans, VIC, Australia; School of Nursing & Midwifery, Faculty of Health, Deakin University, Australia. https://twitter.com/@ProfLindaSweet
| |
Collapse
|
18
|
Scarf VL, Yu S, Viney R, Cheah SL, Dahlen H, Sibbritt D, Thornton C, Tracy S, Homer C. Modelling the cost of place of birth: a pathway analysis. BMC Health Serv Res 2021; 21:816. [PMID: 34391422 PMCID: PMC8364024 DOI: 10.1186/s12913-021-06810-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Accepted: 07/23/2021] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In New South Wales (NSW), Australia there are three settings available for women at low risk of complications to give birth: home, birth centre and hospital. Between 2000 and 2012, 93.6% of babies were planned to be born in hospital, 6.0% in a birth centre and 0.4% at home. Availability of alternative birth settings is limited and the cost of providing birth at home or in a birth centre from the perspective of the health system is unknown. OBJECTIVES The objective of this study was to model the cost of the trajectories of women who planned to give birth at home, in a birth centre or in a hospital from the public sector perspective. METHODS This was a population-based study using linked datasets from NSW, Australia. Women included met the following selection criteria: 37-41 completed weeks of pregnancy, spontaneous onset of labour, and singleton pregnancy at low risk of complications. We used a decision tree framework to depict the trajectories of these women and Australian Refined-Diagnosis Related Groups (AR-DRGs) were applied to each trajectory to estimate the cost of birth. A scenario analysis was undertaken to model the cost for 30 000 women in one year. FINDINGS 496 387 women were included in the dataset. Twelve potential outcome pathways were identified and each pathway was costed using AR-DRGs. An overall cost was also calculated by place of birth: $AUD4802 for homebirth, $AUD4979 for a birth centre birth and $AUD5463 for a hospital birth. CONCLUSION The findings from this study provides some clarity into the financial saving of offering more options to women seeking an alternative to giving birth in hospital. Given the relatively lower rates of complex intervention and neonatal outcomes associated with women at low risk of complications, we can assume the cost of providing them with homebirth and birth centre options could be cost-effective.
Collapse
Affiliation(s)
- Vanessa L Scarf
- Centre for Midwifery, Child and Family Health, Faculty of Health, University of Technology Sydney, PO Box 123 Broadway, Sydney, NSW, 2007, Australia.
| | - Serena Yu
- Centre for Health Economics Research and Evaluation, University of Technology Sydney, Sydney, Australia
| | - Rosalie Viney
- Centre for Health Economics Research and Evaluation, University of Technology Sydney, Sydney, Australia
| | - Seong Leang Cheah
- Centre for Midwifery, Child and Family Health, Faculty of Health, University of Technology Sydney, PO Box 123 Broadway, Sydney, NSW, 2007, Australia
| | - Hannah Dahlen
- School of Nursing and Midwifery, Western Sydney University, Sydney, Australia
| | - David Sibbritt
- Centre for Midwifery, Child and Family Health, Faculty of Health, University of Technology Sydney, PO Box 123 Broadway, Sydney, NSW, 2007, Australia
| | | | - Sally Tracy
- College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
| | - Caroline Homer
- Centre for Midwifery, Child and Family Health, Faculty of Health, University of Technology Sydney, PO Box 123 Broadway, Sydney, NSW, 2007, Australia.,Burnet Institute, Melbourne, Australia
| |
Collapse
|
19
|
Callander EJ, Bull C, McInnes R, Toohill J. The opportunity costs of birth in Australia: Hospital resource savings for a post-COVID-19 era. Birth 2021; 48:274-282. [PMID: 33580537 PMCID: PMC8014177 DOI: 10.1111/birt.12538] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/04/2020] [Revised: 11/03/2020] [Accepted: 01/26/2021] [Indexed: 11/28/2022]
Abstract
BACKGROUND COVID-19 caused significant disruptions to health systems globally; however, restricting the family presence during birth saw an increase in women considering community birth options. This study aimed to quantify the hospital resource savings that could occur if all low-risk women in Australia gave birth at home or in birth centers. METHODS A whole-of-population linked administrative data set containing all women (n = 44 498) who gave birth in Queensland, Australia, between 01/07/2012 and 30/06/2015 was reweighted to represent all Australian women giving birth in 2017. A static microsimulation model of woman and infant health service resource use was created based on 2017 data. The model was comprised of a base model, representing "current" care, and a counterfactual model, representing hypothetical scenarios where all low-risk Australian women gave birth at home or in birth centers. RESULTS If all low-risk women gave birth at home in 2017, cesarean rates would have reduced from 13.4% to 2.7%. Similarly, there would have been 860 fewer inpatient bed days and 10.1 fewer hours of women's intensive care unit time per 1000 births. If all women gave birth in birth centers, cesarean rates would have reduced to 6.7%. In addition, over 760 inpatient bed days would have been saved along with 5.6 hours of women's intensive care unit time per 1000 births. CONCLUSIONS Significant health resource savings could occur by shifting low-risk births from hospitals to home birth and birth center services. Greater examination of Australian women's preferences for home birth and birth center birth models of care is needed.
Collapse
Affiliation(s)
- Emily J. Callander
- Faculty of Medicine, Nursing and Health SciencesSchool of Public Health and Preventive MedicineMonash UniversityMelbourneVICAustralia
| | - Claudia Bull
- School of Nursing and MidwiferyGriffith UniversityGold CoastQLDAustralia
| | - Rhona McInnes
- School of Nursing and MidwiferyGriffith UniversityGold CoastQLDAustralia
| | - Jocelyn Toohill
- Clinical Excellence DivisionQueensland HealthBrisbaneQLDAustralia
| |
Collapse
|
20
|
Blums T, Donnellan-Fernandez R, Sweet L. Inclusion and exclusion criteria for publicly-funded homebirth in Australia: A scoping review. Women Birth 2021; 35:23-30. [PMID: 33541812 DOI: 10.1016/j.wombi.2021.01.009] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2020] [Revised: 12/02/2020] [Accepted: 01/10/2021] [Indexed: 10/22/2022]
Abstract
BACKGROUND There are fifteen publicly-funded homebirth programs currently operating in Australia. Suitability for these programs is determined by a series of inclusion and exclusion criteria. AIM The aim of this scoping review is to identify common inclusion and exclusion criteria for publicly-funded homebirth programs and other related factors that affect access to these programs. METHODS A Google search was conducted for publicly-funded homebirth programs listed on the National Publicly-funded Homebirth Consortium website. Public websites, documents, and policies were analysed to identify inclusion and exclusion criteria for these programs. FINDINGS Eleven of the 15 publicly-funded homebirth programs mention the availability of homebirth on their health service website, with varying levels of information about the inclusion and exclusion criteria available. Two of the programs with no information on their health service website are covered by a state-wide guideline. Additional details were sought directly from programs and obtaining further information from some individual homebirth programs was challenging. Variation in inclusion and exclusion criteria exists between programs. Common areas of variation include restrictions relating to Body Mass Index, parity, age, English language ability, tests required during pregnancy, and gestation at booking to the homebirth program. CONCLUSION The inclusion and exclusion criteria for a publicly-funded homebirth program determines women's access to the program. Limited publicly available information regarding inclusion and exclusion criteria for many publicly-funded homebirth programs is likely to limit women's awareness of and access to these programs.
Collapse
Affiliation(s)
- Tija Blums
- Western Health, St Albans, VIC, Australia; School of Nursing and Midwifery, Griffith University, Australia.
| | - Roslyn Donnellan-Fernandez
- School of Nursing and Midwifery, Griffith University, Australia; Transforming Maternity Care Collaborative, Australia. https://twitter.com/@RozDFernandez
| | - Linda Sweet
- Western Health, St Albans, VIC, Australia; School of Nursing & Midwifery, Faculty of Health, Deakin University, Australia. https://twitter.com/@ProfLindaSweet
| |
Collapse
|
21
|
Grünebaum A, McCullough LB, Orosz B, Chervenak FA. Neonatal mortality in the United States is related to location of birth (hospital versus home) rather than the type of birth attendant. Am J Obstet Gynecol 2020; 223:254.e1-254.e8. [PMID: 32044310 DOI: 10.1016/j.ajog.2020.01.045] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2019] [Revised: 01/23/2020] [Accepted: 01/24/2020] [Indexed: 11/16/2022]
Abstract
BACKGROUND Planned home births have leveled off in the United States in recent years after a significant rise starting in the mid-2000s. Planned home births in the United States are associated with increased patient-risk profiles. Multiple studies concluded that, compared with hospital births, absolute and relative risks of perinatal mortality and morbidity in US planned home births are significantly increased. OBJECTIVE To explore the safety of birth in the United States by comparing the neonatal mortality outcomes of 2 locations, hospital birth and home birth, by 4 types of attendants: hospital midwife; certified nurse-midwife at home; direct-entry ("other") midwife at home; and attendant at home not identified, using the most recent US Centers for Disease Control and Prevention natality data on neonatal mortality for planned home births in the United States. Outcomes are presented as absolute risks (neonatal mortality per 10,000 live births) and as relative risks of neonatal mortality (hospital-certified nurse-midwife odds ratio, 1) overall, and for recognized risk factors. STUDY DESIGN We used the most current US Centers for Disease and Prevention Control Linked Birth and Infant Death Records for 2010-2017 to assess neonatal mortality (neonatal death days 0-27 after birth) for single, term (37+ weeks), normal-weight ( >2499 g) infants for planned home births and hospital births by birth attendants: hospital-certified nurse-midwives, home-certified nurse-midwives, home other midwives (eg, lay or direct-entry midwives), and other home birth attendant not identified. RESULTS The neonatal mortality for US hospital midwife-attended births was 3.27 per 10,000 live births, 13.66 per 10,000 live births for all planned home births, and 27.98 per 10,000 live births for unintended/unplanned home births. Planned home births attended by direct-entry midwives and by certified nurse-midwives had a significantly elevated absolute and relative neonatal mortality risk compared with certified nurse-midwife-attended hospital births (hospital-certified nurse-midwife: 3.27/10,000 live births odds ratio, 1; home birth direct-entry midwives: neonatal mortality 12.44/10,000 live births, odds ratio, 3.81, 95% confidence interval, 3.12-4.65, P<.0001; home birth-certified nurse-midwife: neonatal mortality 9.48/10,000 live births, odds ratio, 2.90, 95% confidence interval, 2.90; P<.0001). These differences increased further when patients were stratified for recognized risk factors. CONCLUSION The safety of birth in the United States varies by location and attendant. Compared with US hospital births attended by a certified nurse-midwife, planned US home births for all types of attendants are a less safe setting of birth, especially when recognized risk factors are taken into account. The type of midwife attending US planned home birth appears to have no differential effect on decreasing the absolute and relative risk of neonatal mortality of planned home birth, because the difference in outcomes of US planned home births attended by direct-entry midwives or by certified nurse-midwives is not statistically significant.
Collapse
Affiliation(s)
- Amos Grünebaum
- Department of Obstetrics and Gynecology, Lenox Hill Hospital, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY.
| | - Laurence B McCullough
- Department of Obstetrics and Gynecology, Lenox Hill Hospital, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY
| | | | - Frank A Chervenak
- Department of Obstetrics and Gynecology, Lenox Hill Hospital, Zucker School of Medicine at Hofstra/Northwell, Hempstead, NY
| |
Collapse
|
22
|
Yuill C, McCourt C, Cheyne H, Leister N. Women's experiences of decision-making and informed choice about pregnancy and birth care: a systematic review and meta-synthesis of qualitative research. BMC Pregnancy Childbirth 2020; 20:343. [PMID: 32517734 PMCID: PMC7285707 DOI: 10.1186/s12884-020-03023-6] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2020] [Accepted: 05/20/2020] [Indexed: 11/18/2022] Open
Abstract
Background The purpose of this systematic review (PROSPERO Ref: CRD42017053264) was to describe and interpret the qualitative research on parent’s decision-making and informed choice about their pregnancy and birth care. Given the growing evidence on the benefits of different models of maternity care and the prominence of informed choice in health policy, the review aimed to shed light on the research to date and what the findings indicate. Methods a systematic search and screening of qualitative research concerning parents’ decision-making and informed choice experiences about pregnancy and birth care was conducted using PRISMA guidelines. A meta-synthesis approach was taken for the extraction and analysis of data and generation of the findings. Studies from 1990s onwards were included to reflect an era of policies promoting choice in maternity care in high-income countries. Results Thirty-seven original studies were included in the review. A multi-dimensional conceptual framework was developed, consisting of three analytical themes (‘Uncertainty’, ‘Bodily autonomy and integrity’ and ‘Performing good motherhood’) and three inter-linking actions (‘Information gathering,’ ‘Aligning with a birth philosophy,’ and ‘Balancing aspects of a choice’). Conclusions Despite the increasing research on decision-making, informed choice is not often a primary research aim, and its development in literature published since the 1990s was difficult to ascertain. The meta-synthesis suggests that decision-making is a dynamic and temporal process, in that it is made within a defined period and invokes both the past, whether this is personal, familial, social or historical, and the future. Our findings also highlighted the importance of embodiment in maternal health experiences, particularly when it comes to decision-making about care. Policymakers and practitioners alike should examine critically current choice frameworks to ascertain whether they truly allow for flexibility in decision-making. Health systems should embrace more fluid, personalised models of care to augment service users’ decision-making agency.
Collapse
Affiliation(s)
- Cassandra Yuill
- Centre for Maternal and Child Health Research, School of Health Sciences, City, University of London, 1 Myddelton Street, London, EC1R 1UW, UK.
| | - Christine McCourt
- Centre for Maternal and Child Health Research, School of Health Sciences, City, University of London, 1 Myddelton Street, London, EC1R 1UW, UK
| | - Helen Cheyne
- Nursing Midwifery and Allied Health Professions, University of Stirling, Stirling, Scotland, FK9 4LA, UK
| | - Nathalie Leister
- Centre for Maternal and Child Health Research, School of Health Sciences, City, University of London, 1 Myddelton Street, London, EC1R 1UW, UK
| |
Collapse
|
23
|
Adelson P, Fleet JA, McKellar L, Eckert M. Two decades of Birth Centre and midwifery-led care in South Australia, 1998-2016. Women Birth 2020; 34:e84-e91. [PMID: 32518041 DOI: 10.1016/j.wombi.2020.05.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 05/14/2020] [Accepted: 05/18/2020] [Indexed: 10/24/2022]
Abstract
BACKGROUND Birth Centres (BC) are underpinned by a philosophy of woman- centred care and were pivotal in growing models of midwifery-led care in South Australia (SA). AIM To describe BC utilisation and the growth of midwifery-led care in SA over the past two decades. METHODS The SA Perinatal Statistics Collection was used to describe women birthing from 1998 to 2016. Number of births through midwifery-led services from 2004 to 2016 were obtained from unit managers. Analyses are descriptive. FINDINGS Women who birthed in BC in SA from 1998 to 2016 comprised approximately 6% of all births per year, and numbers have remained static. Three BC models operate in SA, all with different capacity. Proportionally, women not born in Australia are as likely to birth in BC as labour wards. The proportion of women who received midwifery-led care (whether affiliated with a BC or not), increased from 8.3% in 1998 to 19.2% of all births in 2016. Of the women who received midwifery-led care in 2016, 15.3% went on to birth in a midwifery-led model of care. CONCLUSION Whilst the overall number of BC births has not increased, women seeking midwifery-led care has more than doubled over the past two decades. BC encompass the midwifery philosophy, quality of care, and a physical home-like environment. The BC models in SA are managed through the three tertiary maternity units enabling women to access publicly funded midwifery care and should be more widely available.
Collapse
Affiliation(s)
- Pamela Adelson
- Rosemary Bryant AO Research Centre, Clinical and Health Services, University of South Australia, North Terrace, Adelaide, SA 5000, Australia.
| | - Julie-Anne Fleet
- Clinical and Health Services, University of South Australia, North Terrace, Adelaide, SA 5000, Australia
| | - Lois McKellar
- Clinical and Health Services, University of South Australia, North Terrace, Adelaide, SA 5000, Australia
| | - Marion Eckert
- Rosemary Bryant AO Research Centre, Clinical and Health Services, University of South Australia, North Terrace, Adelaide, SA 5000, Australia
| |
Collapse
|
24
|
Jackson MK, Schmied V, Dahlen HG. Birthing outside the system: the motivation behind the choice to freebirth or have a homebirth with risk factors in Australia. BMC Pregnancy Childbirth 2020; 20:254. [PMID: 32345236 PMCID: PMC7189701 DOI: 10.1186/s12884-020-02944-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Accepted: 04/14/2020] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Childbirth in Australia occurs predominantly in a biomedical context, with 97% of births occurring in hospital. A small percentage of women choose to birth outside the system - that is, to have a midwife attended homebirth with risk factors, or a freebirth, where the birth at home is intentionally unattended by any health professional. METHOD This study used a Grounded Theory methodology. Data from 13 women choosing homebirth and 15 choosing freebirth were collected between 2010 and 2014 and analysed over this time. RESULTS The core category was 'wanting the best and safest,' which describes what motivated the women to birth outside the system. The basic social process, which explains the journey women took as they pursued the best and safest, was 'finding a better way'. Women who gave birth outside the system in Australia had the countercultural belief that their knowledge about what was best and safest had greater authority than the socially accepted experts in maternity care. The women did not believe the rhetoric about the safety of hospitals and considered a biomedical approach towards birth to be the riskier birth option compared to giving birth outside the system. Previous birth experiences taught the women that hospital care was emotionally unsafe and that there was a possibility of further trauma if they returned to hospital. Giving birth outside the system presented the women with what they believed to be the opportunity to experience the best and safest circumstances for themselves and their babies. CONCLUSION Shortfalls in the Australian maternity care system is the major contributing factor to women's choice to give birth outside the system. Systematic improvements should prioritise humanising maternity care and the expansion of birth options which prioritise midwifery-led care for women of all risk.
Collapse
Affiliation(s)
- Melanie K Jackson
- School of Nursing and Midwifery, Western Sydney University, Locked bag 1797, Penrith, NSW 2751 Australia
| | - Virginia Schmied
- School of Nursing and Midwifery, Western Sydney University, Locked bag 1797, Penrith, NSW 2751 Australia
| | - Hannah G Dahlen
- School of Nursing and Midwifery, Western Sydney University, Locked bag 1797, Penrith, NSW 2751 Australia
| |
Collapse
|
25
|
Scarf VL, Viney R, Yu S, Foureur M, Rossiter C, Dahlen H, Thornton C, Cheah SL, Homer CSE. Mapping the trajectories for women and their babies from births planned at home, in a birth centre or in a hospital in New South Wales, Australia, between 2000 and 2012. BMC Pregnancy Childbirth 2019; 19:513. [PMID: 31864317 PMCID: PMC6925447 DOI: 10.1186/s12884-019-2584-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2018] [Accepted: 11/07/2019] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND In New South Wales (NSW) Australia, women at low risk of complications can choose from three birth settings: home, birth centre and hospital. Between 2000 and 2012, around 6.4% of pregnant women planned to give birth in a birth centre (6%) or at home (0.4%) and 93.6% of women planned to birth in a hospital. A proportion of the woman in the home and birth centre groups transferred to hospital. However, their pathways or trajectories are largely unknown. AIM The aim was to map the trajectories and interventions experienced by women and their babies from births planned at home, in a birth centre or in a hospital over a 13-year period in NSW. METHODS Using population-based linked datasets from NSW, women at low risk of complications, with singleton pregnancies, gestation 37-41 completed weeks and spontaneous onset of labour were included. We used a decision tree framework to depict the trajectories of these women and estimate the probabilities of the following: giving birth in their planned setting; being transferred; requiring interventions and neonatal admission to higher level hospital care. The trajectories were analysed by parity. RESULTS Over a 13-year period, 23% of nulliparous and 0.8% of multiparous women planning a home birth were transferred to hospital. In the birth centre group, 34% of nulliparae and 12% of multiparas were transferred to a hospital. Normal vaginal birth rates were higher in multiparous women compared to nulliparous women in all settings. Neonatal admission to SCN/NICU was highest in the planned hospital group for nulliparous women (10.1%), 7.1% for nulliparous women planning a birth centre birth and 5.1% of nulliparous women planning a homebirth. Multiparas had lower admissions to SCN/NICU for all thee settings (hospital 6.3%, BC 3.6%, home 1.6%, respectively). CONCLUSIONS Women who plan to give birth at home or in a birth centre have high rates of vaginal birth, even when transferred to hospital. Evidence on the trajectories of women who choose to give birth at home or in birth centres will assist the planning, costing and expansion of models of care in NSW.
Collapse
Affiliation(s)
- Vanessa L Scarf
- Centre for Midwifery, Child and Family Health, University of Technology Sydney, Sydney, New South Wales, Australia.
| | - Rosalie Viney
- Centre for Health Economic Research and Evaluation (CHERE), University of Technology Sydney, PO Box 123, Broadway, Ultimo, NSW, 2007, Australia
| | - Serena Yu
- Centre for Health Economic Research and Evaluation (CHERE), University of Technology Sydney, PO Box 123, Broadway, Ultimo, NSW, 2007, Australia
| | - Maralyn Foureur
- Centre for Midwifery, Child and Family Health, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Chris Rossiter
- Centre for Midwifery, Child and Family Health, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Hannah Dahlen
- School of Nursing and Midwifery, Western Sydney University, Sydney, Australia
| | - Charlene Thornton
- College of Nursing and Health Sciences, Flinders University, Adelaide, Australia
| | - Seong Leang Cheah
- Centre for Midwifery, Child and Family Health, University of Technology Sydney, Sydney, New South Wales, Australia
| | - Caroline S E Homer
- Centre for Midwifery, Child and Family Health, University of Technology Sydney, Sydney, New South Wales, Australia
| |
Collapse
|