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Olsen O, Clausen JA. Planned hospital birth compared with planned home birth for pregnant women at low risk of complications. Cochrane Database Syst Rev 2023; 3:CD000352. [PMID: 36884026 PMCID: PMC9994459 DOI: 10.1002/14651858.cd000352.pub3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/09/2023]
Abstract
BACKGROUND Observational studies of increasingly better quality and in different settings suggest that planned hospital birth in many places does not reduce mortality and morbidity but increases the frequency of interventions and complications. Euro-Peristat (part of the European Union's Health Monitoring Programme) has raised concerns about iatrogenic effects of obstetric interventions, and the World Health Organization (WHO) has raised concern that the increasing medicalisation of childbirth tends to undermine women's own capability to give birth and negatively impacts their childbirth experience. This is an update of a Cochrane Review first published in 1998, and previously updated in 2012. OBJECTIVES To compare the effects of planned hospital birth with planned home birth attended by a midwife or others with midwifery skills and backed up by a modern hospital system in case a transfer to hospital should turn out to be necessary. The primary focus is on women with an uncomplicated pregnancy and low risk of medical intervention during birth. SEARCH METHODS: For this update, we searched Cochrane Pregnancy and Childbirth's Trials Register (which includes trials from CENTRAL, MEDLINE, Embase, CINAHL, WHO ICTRP, and conference proceedings), ClinicalTrials.gov (16 July 2021), and reference lists of retrieved studies. SELECTION CRITERIA Randomised controlled trials (RCTs) comparing planned hospital birth with planned home birth in low-risk women as described in the objectives. Cluster-randomised trials, quasi-randomised trials, and trials published only as an abstract were also eligible. DATA COLLECTION AND ANALYSIS Two review authors independently assessed trials for inclusion and risk of bias, extracted data, and checked the data for accuracy. We contacted study authors for additional information. We assessed the certainty of the evidence using the GRADE approach. MAIN RESULTS: We included one trial involving 11 participants. This was a small feasibility study to show that well-informed women - contrary to common beliefs - were prepared to be randomised. This update did not identify any additional studies for inclusion, but excluded one study that had been awaiting assessment. The included study was at high risk of bias for three out of seven risk of bias domains. The trial did not report on five of the seven primary outcomes, and reported zero events for one primary outcome (caesarean section), and non-zero events for the remaining primary outcome (baby not breastfed). Maternal mortality, perinatal mortality (non-malformed), Apgar < 7 at 5 minutes, transfer to neonatal intensive care unit, and maternal satisfaction were not reported. The overall certainty of the evidence for the two reported primary outcomes was very low according to our GRADE assessment (downgraded two levels for high overall risk of bias (due to high risk of bias arising from lack of blinding, high risk of selective reporting and lack of ability to check for publication bias) and two levels for very serious imprecision (single study with few events)). AUTHORS' CONCLUSIONS: This review shows that for selected, low-risk pregnant women, the evidence from randomised trials to support that planned hospital birth reduces maternal or perinatal mortality, morbidity, or any other critical outcome is uncertain. As the quality of evidence in favour of home birth from observational studies seems to be steadily increasing, it might be just as important to prepare a regularly updated systematic review including observational studies as described in the Cochrane Handbook for Systematic Reviews of Interventions as to attempt to set up new RCTs. As women and healthcare practitioners may be aware of evidence from observational studies, and as the International Federation of Gynecology and Obstetrics and the International Confederation of Midwives collaboratively conclude that there is strong evidence that out-of-hospital birth supported by a registered midwife is safe, equipoise may no longer exist, and randomised trials may now thus be considered unethical or hardly feasible.
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Affiliation(s)
- Ole Olsen
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen K, Denmark
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Allen J, Gao Y, Dahlen H, Reynolds M, Beckmann M, Cooper C, Kildea S. Is a randomized controlled trial of waterbirth possible? An Australian feasibility study. Birth 2022; 49:697-708. [PMID: 35373861 PMCID: PMC9790445 DOI: 10.1111/birt.12635] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2020] [Revised: 02/15/2022] [Accepted: 03/08/2022] [Indexed: 12/30/2022]
Abstract
BACKGROUND The safety of waterbirth is contested because of the lack of evidence from randomized trials and conflicting results. This research assessed the feasibility of a prospective study of waterbirth (trial or cohort). METHODS We conducted a prospective cohort study at an Australian maternity hospital. Eligible women with uncomplicated pregnancies at 36 weeks of gestation were recruited and surveyed about their willingness for randomization. The primary midwife assessed waterbirth eligibility and intention on admission in labor, and onset of second stage. Primary outcomes measured feasibility. Intention-to-treat analysis, and per-protocol analysis, compared clinical outcomes of women and their babies who intended waterbirth and nonwaterbirth at onset of second stage. RESULTS 1260 participants were recruited; 15% (n = 188) agreed to randomization in a future trial. 550 women were analyzed by intention-to-treat analysis: 351 (waterbirth) and 199 (nonwaterbirth). In per-protocol analysis, 14% (n = 48) were excluded. Women in the waterbirth group were less likely to have amniotomy and more likely to have water immersion and physiological third stage. There were no differences in other measures of maternal morbidity. There were no significant differences between groups for serious neonatal morbidity; four cord avulsions occurred in the waterbirth group with none in the landbirth group. An RCT would need approximately 6000 women to be approached at onset of second stage. CONCLUSIONS A randomized trial of waterbirth compared with nonwaterbirth, powered to detect a difference in serious neonatal morbidity, is unlikely to be feasible. A powered prospective study with intention-to-treat analysis at onset of second stage is feasible.
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Affiliation(s)
- Jyai Allen
- School of Nursing and MidwiferyGriffith UniversityMeadowbrookQueenslandAustralia
| | - Yu Gao
- Molly Wardaguga Research CentreCollege of Nursing and MidwiferyCharles Darwin UniversityBrisbaneQueenslandAustralia
| | - Hannah Dahlen
- School of Nursing and MidwiferyWestern Sydney UniversityPenrithNew South WalesAustralia
| | - Maree Reynolds
- Mater Mothers’ HospitalsRaymond Terrace, South BrisbaneQueenslandAustralia
| | - Michael Beckmann
- Mater Mothers’ HospitalsRaymond Terrace, South BrisbaneQueenslandAustralia
| | - Catherine Cooper
- Mater Mothers’ HospitalsRaymond Terrace, South BrisbaneQueenslandAustralia
| | - Sue Kildea
- Molly Wardaguga Research CentreCollege of Nursing and MidwiferyCharles Darwin UniversityBrisbaneQueenslandAustralia
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Brunton G, Wahab S, Sheikh H, Davis BM. Global stakeholder perspectives of home birth: a systematic scoping review. Syst Rev 2021; 10:291. [PMID: 34727980 PMCID: PMC8561961 DOI: 10.1186/s13643-021-01837-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2021] [Accepted: 10/11/2021] [Indexed: 11/24/2022] Open
Abstract
Home birth is experienced by people very differently worldwide. These experiences likely differ by the type of stakeholder involved (women, their support persons, birth attendants, policy-makers), the experience itself (low-risk birth, transfer to hospital, previous deliveries), and by the health system within which home birth occurs (e.g., high-resource versus low- and middle-resource countries). Research evidence of stakeholders' perspectives of home birth could usefully inform personal and policy decisions about choosing and providing home birth, but the current literature is fragmented and its breadth is not fully understood.We conducted a systematic scoping review to understand how the research literature on stakeholders' perspectives of home birth is characterized in terms of populations, settings and identified issues, and what potential gaps exist in the research evidence. A range of electronic, web-based and key informant sources of evidence were searched. Located references were assessed, data extracted, and descriptively analyzed using robust methods.Our analysis included 460 full reports. Findings from 210 reports of studies in high-resource countries suggested that research with fathers and same-sex partners, midwives, and vulnerable populations and perspectives of freebirth and transfer to hospital could be synthesized. Gaps in primary research exist with respect to family members, policy makers, and those living in rural and remote locations. A further 250 reports of studies in low- and middle-resource countries suggested evidence for syntheses related to fathers and other family members, policy makers, and other health care providers and examination of issues related to emergency transfer to hospital, rural and remote home birth, and those who birth out of hospital, often at home, despite receiving antenatal care intended to increase healthcare-seeking behavior. Gaps in primary research suggest an examination is needed of perspectives in countries with higher maternal mortality and among first-time mothers and young mothers.Our scoping review identified a considerable body of research evidence on stakeholder perspectives of home birth. These could inform the complex factors influencing personal decisions and health system planning around home birth in both high- and low- and middle-resource countries. Future primary research is warranted on specific stakeholders worldwide and with vulnerable populations in areas of high maternal mortality.
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Affiliation(s)
- Ginny Brunton
- Faculty of Health Sciences, Ontario Tech University, Oshawa, ON Canada
| | - Samira Wahab
- Faculty of Health Sciences, Ontario Tech University, Oshawa, ON Canada
| | - Hassan Sheikh
- Faculty of Health Sciences, Ontario Tech University, Oshawa, ON Canada
| | - Beth Murray Davis
- McMaster Midwifery Research Centre, Department of Obstetrics and Gynecology, Faculty of Health Sciences, McMaster University, Hamilton, ON Canada
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Alcaraz-Vidal L, Escuriet R, Sàrries Zgonc I, Robleda G. Planned homebirth in Catalonia (Spain): A descriptive study. Midwifery 2021; 98:102977. [PMID: 33751929 DOI: 10.1016/j.midw.2021.102977] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/07/2020] [Revised: 02/17/2021] [Accepted: 03/01/2021] [Indexed: 12/23/2022]
Affiliation(s)
- L Alcaraz-Vidal
- PhD candidate, Biomedicine Programme, Department of Experimental and Health Sciences, University Pompeu Fabra. Barcelona, Spain; Midwife Coordinator Birth Centre Project, Germans Trias i Pujol Hospital, Carretera del Canyet S/N 08, Badalona, Spain; Sexual and Reproductive Health Research Group, (GRASSIR), Catalan Health Institute Barcelona, Spain; Catalan Association of Homebirth Midwives, Spain.
| | - R Escuriet
- Faculty of Health Sciences, Universitat Ramon Llull. Global Health Gender and Society (GHenderS) Research Group. Barcelona, Spain; Catalan Health Service. Government of Catalonia, Spain
| | - I Sàrries Zgonc
- Catalan Association of Homebirth Midwives, Spain; Independent RM, Spain
| | - G Robleda
- Campus Docent Fundació Privada Sant Joan de Déu, School of Nursing, University of Barcelona. Spain; Iberoamerican Cochrane Centre. Barcelona, Spain
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Reitsma A, Simioni J, Brunton G, Kaufman K, Hutton EK. Maternal outcomes and birth interventions among women who begin labour intending to give birth at home compared to women of low obstetrical risk who intend to give birth in hospital: A systematic review and meta-analyses. EClinicalMedicine 2020; 21:100319. [PMID: 32280941 PMCID: PMC7136633 DOI: 10.1016/j.eclinm.2020.100319] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/21/2020] [Revised: 03/09/2020] [Accepted: 03/10/2020] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND We previously concluded that risk of stillbirth, neonatal mortality or morbidity is not different whether birth is intended at home or hospital. Here, we compare the occurrence of birth interventions and maternal outcomes among low-risk women who begin labour intending to birth at home compared to women intending to birth in hospital. METHODS We used our registered protocol (PROSPERO, http://www.crd.york.ac.uk, No.CRD42013004046) and searched five databases from 1990-2018. Using R, we obtained pooled estimates of effect (accounting for study design, study setting and parity). FINDINGS 16 studies provided data from ~500,000 intended home births for the meta-analyses. There were no reported maternal deaths. When controlling for parity in well-integrated settings we found women intending to give birth at home compared to hospital were less likely to experience: caesarean section OR 0.58(0.44,0.77); operative vaginal birth OR 0.42(0.23,0.76); epidural analgesia OR 0.30(0.24,0.38); episiotomy OR 0.45(0.28,0.73); 3rd or 4th degree tear OR 0.57(0.43,0.75); oxytocin augmentation OR 0.37(0.26,0.51) and maternal infection OR 0.23(0.15,0.35). Pooled results for postpartum haemorrhage showed women intending home births were either less likely or did not differ from those intending hospital birth [OR 0.66(0.54,0.80) and RR 1.30(0.79,2.13) from 2 studies that could not be pooled with the others]. Similar results were found when data were stratified by parity and by degree of integration into health systems. INTERPRETATION Among low-risk women, those intending to birth at home experienced fewer birth interventions and untoward maternal outcomes. These findings along with earlier work reporting neonatal outcomes inform families, health care providers and policy makers around the safety of intended home births. FUNDING Partial funding: Association of Ontario Midwives open peer reviewed grant.
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Affiliation(s)
- Angela Reitsma
- McMaster Midwifery Research Centre, McMaster University, Hamilton, Ontario, Canada
| | - Julia Simioni
- McMaster Midwifery Research Centre, McMaster University, Hamilton, Ontario, Canada
| | - Ginny Brunton
- Faculty of Health Sciences, Ontario Tech University, Oshawa Canada
| | - Karyn Kaufman
- McMaster Midwifery Research Centre, McMaster University, Hamilton, Ontario, Canada
| | - Eileen K Hutton
- McMaster Midwifery Research Centre, McMaster University, Hamilton, Ontario, Canada
- Department of Obstetrics and Gynecology, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
- Corresponding author at: McMaster University, 1280 Main Street West, HSC 4H24, Hamilton, Ontario, Canada.
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Hutton EK, Reitsma A, Simioni J, Brunton G, Kaufman K. Perinatal or neonatal mortality among women who intend at the onset of labour to give birth at home compared to women of low obstetrical risk who intend to give birth in hospital: A systematic review and meta-analyses. EClinicalMedicine 2019; 14:59-70. [PMID: 31709403 PMCID: PMC6833447 DOI: 10.1016/j.eclinm.2019.07.005] [Citation(s) in RCA: 44] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2019] [Revised: 05/24/2019] [Accepted: 07/16/2019] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND More women are choosing to birth at home in well-resourced countries. Concerns persist that out-of-hospital birth contributes to higher perinatal and neonatal mortality. This systematic review and meta-analyses determines if risk of fetal or neonatal loss differs among low-risk women who begin labour intending to give birth at home compared to low-risk women intending to give birth in hospital. METHODS In April 2018 we searched five databases from 1990 onward and used R to obtain pooled estimates of effect. We stratified by study design, study settings and parity. The primary outcome is any perinatal or neonatal death after the onset of labour. The study protocol is peer-reviewed, published and registered (PROSPERO No.CRD42013004046). FINDINGS We identified 14 studies eligible for meta-analysis including ~ 500,000 intended home births. Among nulliparous women intending a home birth in settings where midwives attending home birth are well-integrated in health services, the odds ratio (OR) of perinatal or neonatal mortality compared to those intending hospital birth was 1.07 (95% Confidence Interval [CI], 0.70 to 1.65); and in less integrated settings 3.17 (95% CI, 0.73 to 13.76). Among multiparous women intending a home birth in well-integrated settings, the estimated OR compared to those intending a hospital birth was 1.08 (95% CI, 0.84 to 1.38); and in less integrated settings was 1.58 (95% CI, 0.50 to 5.03). INTERPRETATION The risk of perinatal or neonatal mortality was not different when birth was intended at home or in hospital. FUNDING Partial funding: Association of Ontario Midwives open peer reviewed grant. RESEARCH IN CONTEXT Evidence before this study Although there is increasing acceptance for intended home birth as a choice for birthing women, controversy about its safety persists. The varying responses of obstetrical societies to intended home birth provide evidence of contrasting views. A Cochrane review of randomised controlled trials addressing this topic included one small trial and noted that in the absence of adequately sized randomised controlled trials on the topic of intended home compared to intended hospital birth, a peer reviewed protocol be published to guide a systematic review and meta-analysis including observational studies. Reviews to date have been limited by design or methodological issues and none has used a protocol published a priori.Added value of this study Individual studies are underpowered to detect small but potentially important differences in rare outcomes. This study uses a published peer-reviewed protocol and is the largest and most comprehensive meta-analysis comparing outcomes of intended home and hospital birth. We take study design, parity and jurisdictional support for home birth into account. Our study provides much needed information to policy makers, care providers and women and families when planning for birth.Implications of all the available evidence Women who are low risk and who intend to give birth at home do not appear to have a different risk of fetal or neonatal loss compared to a population of similarly low risk women intending to give birth in hospital.
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Affiliation(s)
- Eileen K. Hutton
- Department of Obstetrics and Gynecology, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
- Midwifery Education Program, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Angela Reitsma
- Midwifery Education Program, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Julia Simioni
- Midwifery Education Program, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
| | - Ginny Brunton
- EPPI-Centre, Department of Social Science, UCL Institute of Education, University College London, United Kingdom
| | - Karyn Kaufman
- Midwifery Education Program, Faculty of Health Sciences, McMaster University, Hamilton, Ontario, Canada
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Dahlen HG. Is it Time to Ask Whether Facility Based Birth is Safe for Low Risk Women and Their Babies? EClinicalMedicine 2019; 14:9-10. [PMID: 31709395 PMCID: PMC6833440 DOI: 10.1016/j.eclinm.2019.08.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2019] [Accepted: 08/05/2019] [Indexed: 01/08/2023] Open
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Comeau A, Hutton EK, Simioni J, Anvari E, Bowen M, Kruegar S, Darling EK. Home birth integration into the health care systems of eleven international jurisdictions. Birth 2018; 45:311-321. [PMID: 29436048 DOI: 10.1111/birt.12339] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Revised: 12/22/2017] [Accepted: 12/26/2017] [Indexed: 01/10/2023]
Abstract
BACKGROUND The purpose of this study was to develop assessment criteria that could be used to examine the level of integration of home birth within larger health care systems in developed countries across 11 international jurisdictions. METHODS An expert panel developed criteria and a definition to assess home birth integration within health care systems. We selected jurisdictions based on the publications that were eligible for inclusion in our systematic review and meta-analysis on planned place of birth. We sent the authors of the included publications a questionnaire about home birth practitioners and practices in their respective health care system at the time of their studies. We searched published peer-reviewed, non-peer-reviewed, and gray literature, and the websites of professional bodies to document information about home birth integration in each jurisdiction based on our criteria. Where information was lacking, we contacted experts in the field from the relevant jurisdiction. RESULTS Home birth is well integrated into the health care system in British Columbia (Canada), England, Iceland, the Netherlands, New Zealand, Ontario (Canada), and Washington State (USA). Home birth is less well integrated into the health care system in Australia, Japan, Norway, and Sweden. CONCLUSIONS This paper is the first to propose criteria for the evaluation of home birth integration within larger maternity care systems. Application of these criteria across 11 international jurisdictions indicates differences in the recognition and training of home birth practitioners, in access to hospital facilities, and in the supplies and equipment available at home births, which give rise to variation in the level of integration across different settings. Standardized criteria for the evaluation of systems integration are essential for interpreting planned home birth outcomes that emerge from contextual differences.
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Affiliation(s)
- Amanda Comeau
- McMaster Midwifery Education Program, McMaster University, Hamilton, Ontario, Canada
| | - Eileen K Hutton
- McMaster Midwifery Education Program, McMaster University, Hamilton, Ontario, Canada.,Department of Obstetrics & Gynecology, McMaster University, Hamilton, Ontario, Canada
| | - Julia Simioni
- McMaster Midwifery Education Program, McMaster University, Hamilton, Ontario, Canada.,Department of Obstetrics & Gynecology, McMaster University, Hamilton, Ontario, Canada
| | - Ella Anvari
- McMaster Midwifery Education Program, McMaster University, Hamilton, Ontario, Canada
| | - Megan Bowen
- McMaster Midwifery Education Program, McMaster University, Hamilton, Ontario, Canada
| | - Samantha Kruegar
- McMaster Midwifery Education Program, McMaster University, Hamilton, Ontario, Canada
| | - Elizabeth K Darling
- McMaster Midwifery Education Program, McMaster University, Hamilton, Ontario, Canada.,Department of Obstetrics & Gynecology, McMaster University, Hamilton, Ontario, Canada
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Vedam S, Rossiter C, Homer CSE, Stoll K, Scarf VL. The ResQu Index: A new instrument to appraise the quality of research on birth place. PLoS One 2017; 12:e0182991. [PMID: 28797127 PMCID: PMC5552354 DOI: 10.1371/journal.pone.0182991] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2017] [Accepted: 07/27/2017] [Indexed: 12/13/2022] Open
Abstract
Objective Place of birth is a known determinant of health care outcomes, interventions and costs. Many studies have examined the maternal and perinatal outcomes when women plan to give birth in hospitals compared with births in birth centres or at home. However, these studies vary substantially in rigour; assessing their quality is challenging. Existing research appraisal tools do not always capture important elements of study design that are critical when comparing outcomes by planned place of birth. To address this deficiency, we aimed to develop a reliable instrument to rate the quality of primary research on maternal and newborn outcomes by place of birth. Study design The instrument development process involved five phases: 1) generation of items and a weighted scoring system; 2) content validation via a quantitative survey and a modified Delphi process with an international, multi-disciplinary panel of experts; 3) inter-rater consistency; 4) alignment with established research appraisal tools; and 5) pilot-testing of instrument usability. Results A Birth Place Research Quality Index (ResQu Index) was developed comprising 27 scored items that are summed to generate a weighted composite score out of 100 for studies comparing planned place of birth. Scale content validation indices were .89 for clarity, .94 for relevance and .90 for importance. The Index demonstrated substantial inter-rater consistency; pilot-testing confirmed feasibility and user-friendliness. Conclusion The ResQu Index is a reliable instrument to evaluate the quality of design, methods and interpretation of reported outcomes from research about place of birth. Higher-scoring studies have greater potential to inform evidence-based selection of birth place by clinicians, policy makers, and women and their families. The Index can also guide the design of future research on place of birth.
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Affiliation(s)
- Saraswathi Vedam
- Centre for Midwifery, Child and Family Health, Faculty of Health, University of Technology Sydney, Broadway, NSW, Australia
- UBC Midwifery Faculty of Medicine, University of British Columbia, University Boulevard, Vancouver, BC, Canada
| | - Chris Rossiter
- Centre for Midwifery, Child and Family Health, Faculty of Health, University of Technology Sydney, Broadway, NSW, Australia
| | - Caroline S. E. Homer
- Centre for Midwifery, Child and Family Health, Faculty of Health, University of Technology Sydney, Broadway, NSW, Australia
| | - Kathrin Stoll
- UBC Midwifery Faculty of Medicine, University of British Columbia, University Boulevard, Vancouver, BC, Canada
| | - Vanessa L. Scarf
- Centre for Midwifery, Child and Family Health, Faculty of Health, University of Technology Sydney, Broadway, NSW, Australia
- * E-mail:
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Affiliation(s)
- Eileen K Hutton
- Department of Obstetrics and Gynaecology, McMaster University, Hamilton ON
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