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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.
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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
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Alcaraz-Vidal L, Leon-Larios F, Robleda G, Vila-Candel R. Exploring home births in Catalonia (Spain): A cross-sectional study of women's experiences and influencing factors. J Adv Nurs 2024; 80:2363-2378. [PMID: 38012827 DOI: 10.1111/jan.15989] [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: 08/08/2023] [Revised: 11/09/2023] [Accepted: 11/13/2023] [Indexed: 11/29/2023]
Abstract
AIM The study explores the experiences of women with low-risk pregnancies and no complications who planned a home birth. DESIGN A cross-sectional study was conducted using an online questionnaire. METHODS The questionnaire included socio-demographic, obstetric and perinatal variables. Birth satisfaction was evaluated via the Spanish version of the childbirth experience questionnaire. The study group comprised home-birthing women in Catalonia, Spain. Data were collected from 1 January 2019 to 31 December 2021. Statistical analysis was performed using SPSS. RESULTS A total of 236 women responded. They reported generally positive experiences, with professional support and involvement being the most highly rated dimensions. Better childbirth experiences were associated with labour lasting less than 12 h, no perineal injuries, no intrapartum transfers to hospital, euthocic delivery and the presence of a midwife. CONCLUSIONS Women's positive home birth experiences were linked to active participation and midwife support. Multiparous women felt safer. Medical interventions, especially transfers to hospitals, reduced satisfaction, highlighting the need for improved care during home births. IMPLICATIONS FOR THE PROFESSION AND PATIENT CARE Home births should be included among the birthplace options offered by public health services, given the extremely positive feedback reported by women who gave birth at home. IMPACT Home birth is not an option offered under Catalonia's public health system only as a private service. The experience of home-birthing women is unknown. This study shows a very positive birth experience due to greater participation and midwife support. The results help stakeholders assess home birth's public health inclusion and understand valued factors, supporting home-birthing women. REPORTING METHOD The study followed the STROBE checklist guidelines for cross-sectional studies. PUBLIC CONTRIBUTION Women who planned a home birth participated in the pilot test to validate the instrument, and their contributions were collected by the lead researcher. The questionnaire gathered the participants' email addresses, and a commitment was made to disseminate the study's results through this means.
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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, Spain
- Catalan Association of Home Birth Midwives, Barcelona, Spain
| | - Fatima Leon-Larios
- Nursing Department. Faculty of Nursing, Physiotherapy and Podiatry, University of Seville, Sevilla, Spain
| | - Gemma Robleda
- Campus Docent Fundació Privada Sant Joan de Déu, School of Nursing, University of Barcelona, Barcelona, Spain
- Centro Cochrane Iberoamericano, Barcelona, Spain
| | - Rafael Vila-Candel
- Faculty of Health Sciences, International University of Valencia -VIU, Valencia, Spain
- Department of Primary Health, Foundation for Promoting of Health and Biomedical Research in the Valencian Region (FISABIO-SP), Valencia, Spain
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Galera-Barbero TM, Aguilera-Manrique G, Correia TIG, Fernandes HJ. Adaptation and validation of the Portuguese version of the provider attitudes towards planned home birth (PAPHB) Scale. Midwifery 2023; 119:103609. [PMID: 36804674 DOI: 10.1016/j.midw.2023.103609] [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: 09/06/2022] [Revised: 01/24/2023] [Accepted: 01/29/2023] [Indexed: 02/05/2023]
Abstract
Maternity health care professionals' attitudes on the option of home birth can influence the choices and decisions women and their partners make about place of birth. Midwives are particularly influential in this space. The study outlined in this paper aimed to translate and validate the Provider Attitudes towards Planned Home Birth (PAPHB) scale questionnaire for use in the Portuguese maternity context. METHODS A total of 118 Portuguese midwives were selected through intentional sampling. The procedure was divided into two phases. In the first phase, a triple translation from the original language into Portuguese and a cross-cultural adaptation of the Provider Attitudes towards Planned Home Birth (PAPHB) scale were carried out, obtaining three versions of the same questionnaire. The second phase consisted of the validation of the questionnaire, for which the Provider Attitudes towards Planned Home Birth (PAPHB) scale was submitted to a panel of 20 experts and to a pilot test. Subsequently, the reliability and statistical validity of the scale were evaluated. RESULTS After content analysis, the results confirmed a four-dimensional structure with a Cronbach's α value of 0.933 for the Provider Attitudes towards Planned Home Birth (PAPHB) scale as a whole, showing good internal consistency. Finally, a bivariate analysis was carried out identifying associations between variables and midwives' attitudes towards home birth. Positive attitudes towards homebirth were strongly influenced by previous clinical experience and exposure to home birth during midwives' academic education. CONCLUSION The 18-item scale is a reliable and valid tool to quantify attitudes towards planned home births in Portugal as the results obtained in the study showed very good internal consistency.
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Affiliation(s)
- Trinidad María Galera-Barbero
- Midwife of the Spanish National Health, Department of Nursing, Physiotherapy and Medicine, Faculty of Health Sciences, University of Almería, 04120 Almería, Spain.
| | | | - Teresa Isaltina Gomes Correia
- Midwife, Research Group for Health Sciences, UICISA:E, Professor of the Polytechnic Institute of Bragança, 5300-146 Bragança, Portugal
| | - Hélder Jaime Fernandes
- Research Group for Health Sciences, UICISA:E, Professor of the Polytechnic Institute of Bragança, 5300-146 Bragança, Portugal
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Albersen M, van der Beek SL, Dijkstra IME, Alders M, Barendsen RW, Bliek J, Boelen A, Ebberink MS, Ferdinandusse S, Goorden SMI, Heijboer AC, Jansen M, Jaspers YRJ, Metgod I, Salomons GS, Vaz FM, Verschoof-Puite RK, Visser WF, Dekkers E, Engelen M, Kemp S. Sex-specific newborn screening for X-linked adrenoleukodystrophy. J Inherit Metab Dis 2023; 46:116-128. [PMID: 36256460 PMCID: PMC10092852 DOI: 10.1002/jimd.12571] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/30/2022] [Revised: 09/27/2022] [Accepted: 10/17/2022] [Indexed: 02/07/2023]
Abstract
Males with X-linked adrenoleukodystrophy (ALD) are at high risk for developing adrenal insufficiency and/or progressive leukodystrophy (cerebral ALD) at an early age. Pathogenic variants in ABCD1 result in elevated levels of very long-chain fatty acids (VLCFA), including C26:0-lysophosphatidylcholine (C26:0-LPC). Newborn screening for ALD enables prospective monitoring and timely therapeutic intervention, thereby preventing irreversible damage and saving lives. The Dutch Health Council recommended to screen only male newborns for ALD without identifying untreatable conditions associated with elevated C26:0-LPC, like Zellweger spectrum disorders and single peroxisomal enzyme defects. Here, we present the results of the SCAN (Screening for ALD in the Netherlands) study which is the first sex-specific newborn screening program worldwide. Males with ALD are identified based on elevated C26:0-LPC levels, the presence of one X-chromosome and a variant in ABCD1, in heel prick dried bloodspots. Screening of 71 208 newborns resulted in the identification of four boys with ALD who, following referral to the pediatric neurologist and confirmation of the diagnosis, enrolled in a long-term follow-up program. The results of this pilot show the feasibility of employing a boys-only screening algorithm that identifies males with ALD without identifying untreatable conditions. This approach will be of interest to countries that are considering ALD newborn screening but are reluctant to identify girls with ALD because for girls there is no direct health benefit. We also analyzed whether gestational age, sex, birth weight and age at heel prick blood sampling affect C26:0-LPC concentrations and demonstrate that these covariates have a minimal effect.
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Affiliation(s)
- Monique Albersen
- Endocrine Laboratory, Department of Clinical Chemistry, Amsterdam UMC location University of Amsterdam, Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, The Netherlands
| | - Samantha L van der Beek
- Reference Laboratory for Neonatal Screening, Center for Health Protection, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Inge M E Dijkstra
- Laboratory Genetic Metabolic Diseases, Department of Clinical Chemistry, Amsterdam UMC Location University of Amsterdam, Amsterdam Neuroscience, Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, The Netherlands
| | - Mariëlle Alders
- Department of Human Genetics, Amsterdam UMC location University of Amsterdam, Amsterdam Reproduction & Development, Amsterdam, The Netherlands
| | - Rinse W Barendsen
- Laboratory Genetic Metabolic Diseases, Department of Clinical Chemistry, Amsterdam UMC Location University of Amsterdam, Amsterdam Neuroscience, Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, The Netherlands
| | - Jet Bliek
- Department of Human Genetics, Amsterdam UMC location University of Amsterdam, Amsterdam Reproduction & Development, Amsterdam, The Netherlands
| | - Anita Boelen
- Endocrine Laboratory, Department of Clinical Chemistry, Amsterdam UMC location University of Amsterdam, Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, The Netherlands
| | - Merel S Ebberink
- Laboratory Genetic Metabolic Diseases, Department of Clinical Chemistry, Amsterdam UMC Location University of Amsterdam, Amsterdam Neuroscience, Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, The Netherlands
| | - Sacha Ferdinandusse
- Laboratory Genetic Metabolic Diseases, Department of Clinical Chemistry, Amsterdam UMC Location University of Amsterdam, Amsterdam Neuroscience, Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, The Netherlands
| | - Susan M I Goorden
- Laboratory Genetic Metabolic Diseases, Department of Clinical Chemistry, Amsterdam UMC Location University of Amsterdam, Amsterdam Neuroscience, Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, The Netherlands
| | - Annemieke C Heijboer
- Endocrine Laboratory, Department of Clinical Chemistry, Amsterdam UMC location University of Amsterdam, Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, The Netherlands
- Endocrine Laboratory, Department of Clinical Chemistry, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, The Netherlands
| | - Mandy Jansen
- Department for Vaccine Supply and Prevention Programs, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Yorrick R J Jaspers
- Laboratory Genetic Metabolic Diseases, Department of Clinical Chemistry, Amsterdam UMC Location University of Amsterdam, Amsterdam Neuroscience, Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, The Netherlands
| | - Ingrid Metgod
- Endocrine Laboratory, Department of Clinical Chemistry, Amsterdam UMC location University of Amsterdam, Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, The Netherlands
| | - Gajja S Salomons
- Laboratory Genetic Metabolic Diseases, Department of Clinical Chemistry, Amsterdam UMC Location University of Amsterdam, Amsterdam Neuroscience, Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, The Netherlands
- Department of Pediatric Neurology, Amsterdam UMC location University of Amsterdam, Amsterdam Leukodystrophy Center, Emma Children's Hospital, Amsterdam Neuroscience, Amsterdam, The Netherlands
| | - Frédéric M Vaz
- Laboratory Genetic Metabolic Diseases, Department of Clinical Chemistry, Amsterdam UMC Location University of Amsterdam, Amsterdam Neuroscience, Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, The Netherlands
| | - Rendelien K Verschoof-Puite
- Department for Vaccine Supply and Prevention Programs, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Wouter F Visser
- Reference Laboratory for Neonatal Screening, Center for Health Protection, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Eugènie Dekkers
- Center for Population Screening, National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Marc Engelen
- Department of Pediatric Neurology, Amsterdam UMC location University of Amsterdam, Amsterdam Leukodystrophy Center, Emma Children's Hospital, Amsterdam Neuroscience, Amsterdam, The Netherlands
| | - Stephan Kemp
- Laboratory Genetic Metabolic Diseases, Department of Clinical Chemistry, Amsterdam UMC Location University of Amsterdam, Amsterdam Neuroscience, Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam, The Netherlands
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Šťastná A, Fait T, Kocourková J, Waldaufová E. Does Advanced Maternal Age Comprise an Independent Risk Factor for Caesarean Section? A Population-Wide Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 20:668. [PMID: 36612987 PMCID: PMC9819592 DOI: 10.3390/ijerph20010668] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 11/09/2022] [Revised: 12/23/2022] [Accepted: 12/28/2022] [Indexed: 06/17/2023]
Abstract
OBJECTIVE To investigate the association between a mother's age and the risk of caesarean section (CS) when controlling for health factors and selected sociodemographic characteristics. METHODS Binary logistic regression models for all women who gave birth in Czechia in 2018 (N = 111,749 mothers who gave birth to 113,234 children). RESULTS An increase in the age of a mother significantly increases the odds of a CS birth according to all of the models; depending on the model, OR: 1.62 (95% CI 1.54-1.71) to 1.84 (95% CI 1.70-1.99) for age group 35-39 and OR: 2.83 (95% CI 2.60-3.08) to 3.71 (95% CI 3.23-4.27) for age group 40+ compared to age group 25-29. This strong association between the age of a mother and the risk of CS is further reinforced for primiparas (probability of a CS: 11% for age category ≤ 19, 23% for age category 35-39, and 38% for age category 40+). However, the increasing educational attainment of young women appears to have weakened the influence of increasing maternal age on the overall share of CS births; depending on the model, OR: 0.86 (95% CI 0.80-0.91) to 0.87 (95% CI 0.83-0.91) for tertiary-educated compared to secondary-educated women. CONCLUSIONS The age of a mother comprises an independent risk factor for a CS birth when the influence of health, socioeconomic, and demographic characteristics is considered.
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Affiliation(s)
- Anna Šťastná
- Department of Demography and Geodemography, Faculty of Science, Charles University, 128 00 Praha, Czech Republic
| | - Tomáš Fait
- Department of Demography and Geodemography, Faculty of Science, Charles University, 128 00 Praha, Czech Republic
- Department of Gynaecology and Obstetrics, 2nd Faculty of Medicine, Charles University, 150 06 Praha, Czech Republic
- Department of Health Care Studies, College of Polytechnics Jihlava, 586 01 Jihlava, Czech Republic
| | - Jiřina Kocourková
- Department of Demography and Geodemography, Faculty of Science, Charles University, 128 00 Praha, Czech Republic
| | - Eva Waldaufová
- Department of Demography and Geodemography, Faculty of Science, Charles University, 128 00 Praha, Czech Republic
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