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
|
Hill J, Zinsser LA, Wiemer A, Gross MM, Stoll K. Intrapartum time intervals and transfer of nulliparae from community births to maternity care units in Germany. Birth 2024; 51:39-51. [PMID: 37593788 DOI: 10.1111/birt.12752] [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: 02/21/2023] [Revised: 06/23/2023] [Accepted: 07/10/2023] [Indexed: 08/19/2023]
Abstract
BACKGROUND Over one-third of nulliparae planning births either at home or in freestanding midwife-led birthing centers (community births) in high-income countries are transferred during labor. Perinatal data are reported each year in Germany for women planning community birth. So far, data sets have not been linked to describe time-related factors associated with nulliparous transfer to hospital. OBJECTIVES To describe the prevalence of referral for nulliparae and assess maternal and labor characteristics associated with intrapartum transfer. METHODS Perinatal data from 2010 to 2015 were linked (n = 26,115). Women were reviewed with respect to international eligibility criteria for community birth; 1997 women were excluded (7.6%). Descriptive statistics were reported; unadjusted and adjusted odds ratios with 95% confidence intervals (CI) tested the predictive effect of demographic and labor factors on rates of intrapartum transfer. RESULTS One in three nulliparous women (30.6%) were transferred to hospital. Compared with community births, transferred women were significantly more likely to experience longer time intervals during labor: from rupture of membranes (ROM) until birth lasting 5 to 18 h (OR 6.05, CI 5.53-6.61) and 19 to 24 h (OR 10.83, CI 9.45-12.41) compared to one to 4 h; and from onset of labor until birth 11 to 24 h (OR 6.72, CI 6.24-7.23) and 25 to 29 h (OR 26.62, CI 22.77-31.11) compared to one to 10 h. When entering all factors into the model, we found the strongest predictors of transfer to be fetal distress, longer time intervals between ROM until birth and onset of labor until birth. CONCLUSIONS Nulliparous transfer rates were similar to rates in other high-income countries; 94% of referrals were non-urgent. Time was found to be an independent risk factor for the transfer of nulliparae planning community birth.
Collapse
Affiliation(s)
- Janice Hill
- Midwifery Research and Education Unit, Hannover Medical School, Hannover, Germany
- Department of Midwifery Research, Institute of Health Sciences, Faculty of Medicine, University of Tübingen, Tubingen, Germany
| | - Laura A Zinsser
- Midwifery Research and Education Unit, Hannover Medical School, Hannover, Germany
| | - Anke Wiemer
- Society for Quality in Out of Hospital Birth (QUAG), Hinter den Höfen 2, Storkow, Germany
| | - Mechthild M Gross
- Midwifery Research and Education Unit, Hannover Medical School, Hannover, Germany
| | - Kathrin Stoll
- Midwifery Research and Education Unit, Hannover Medical School, Hannover, Germany
- Department of Family Practice, Faculty of Medicine, University of British Columbia, 5950 University Boulevard, Vancouver, British Columbia, Canada
| |
Collapse
|
3
|
Olsen O, Clausen JA. Planned hospital birth compared with planned home birth for pregnant women at low risk of complications. Cochrane Database Syst Rev 2023; 3:CD000352. [PMID: 36884026 PMCID: PMC9994459 DOI: 10.1002/14651858.cd000352.pub3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/09/2023]
Abstract
BACKGROUND Observational studies of increasingly better quality and in different settings suggest that planned hospital birth in many places does not reduce mortality and morbidity but increases the frequency of interventions and complications. Euro-Peristat (part of the European Union's Health Monitoring Programme) has raised concerns about iatrogenic effects of obstetric interventions, and the World Health Organization (WHO) has raised concern that the increasing medicalisation of childbirth tends to undermine women's own capability to give birth and negatively impacts their childbirth experience. This is an update of a Cochrane Review first published in 1998, and previously updated in 2012. OBJECTIVES To compare the effects of planned hospital birth with planned home birth attended by a midwife or others with midwifery skills and backed up by a modern hospital system in case a transfer to hospital should turn out to be necessary. The primary focus is on women with an uncomplicated pregnancy and low risk of medical intervention during birth. SEARCH METHODS: For this update, we searched Cochrane Pregnancy and Childbirth's Trials Register (which includes trials from CENTRAL, MEDLINE, Embase, CINAHL, WHO ICTRP, and conference proceedings), ClinicalTrials.gov (16 July 2021), and reference lists of retrieved studies. SELECTION CRITERIA Randomised controlled trials (RCTs) comparing planned hospital birth with planned home birth in low-risk women as described in the objectives. Cluster-randomised trials, quasi-randomised trials, and trials published only as an abstract were also eligible. DATA COLLECTION AND ANALYSIS Two review authors independently assessed trials for inclusion and risk of bias, extracted data, and checked the data for accuracy. We contacted study authors for additional information. We assessed the certainty of the evidence using the GRADE approach. MAIN RESULTS: We included one trial involving 11 participants. This was a small feasibility study to show that well-informed women - contrary to common beliefs - were prepared to be randomised. This update did not identify any additional studies for inclusion, but excluded one study that had been awaiting assessment. The included study was at high risk of bias for three out of seven risk of bias domains. The trial did not report on five of the seven primary outcomes, and reported zero events for one primary outcome (caesarean section), and non-zero events for the remaining primary outcome (baby not breastfed). Maternal mortality, perinatal mortality (non-malformed), Apgar < 7 at 5 minutes, transfer to neonatal intensive care unit, and maternal satisfaction were not reported. The overall certainty of the evidence for the two reported primary outcomes was very low according to our GRADE assessment (downgraded two levels for high overall risk of bias (due to high risk of bias arising from lack of blinding, high risk of selective reporting and lack of ability to check for publication bias) and two levels for very serious imprecision (single study with few events)). AUTHORS' CONCLUSIONS: This review shows that for selected, low-risk pregnant women, the evidence from randomised trials to support that planned hospital birth reduces maternal or perinatal mortality, morbidity, or any other critical outcome is uncertain. As the quality of evidence in favour of home birth from observational studies seems to be steadily increasing, it might be just as important to prepare a regularly updated systematic review including observational studies as described in the Cochrane Handbook for Systematic Reviews of Interventions as to attempt to set up new RCTs. As women and healthcare practitioners may be aware of evidence from observational studies, and as the International Federation of Gynecology and Obstetrics and the International Confederation of Midwives collaboratively conclude that there is strong evidence that out-of-hospital birth supported by a registered midwife is safe, equipoise may no longer exist, and randomised trials may now thus be considered unethical or hardly feasible.
Collapse
Affiliation(s)
- Ole Olsen
- The Research Unit for General Practice and Section of General Practice, Department of Public Health, University of Copenhagen, Copenhagen K, Denmark
| | | |
Collapse
|
4
|
Galera-Barbero TM, Aguilera-Manrique G. Planned Home Birth in Low-Risk Pregnancies in Spain: A Descriptive Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18073784. [PMID: 33916388 PMCID: PMC8038591 DOI: 10.3390/ijerph18073784] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 04/01/2021] [Accepted: 04/02/2021] [Indexed: 11/29/2022]
Abstract
Previous studies have shown that planned home birth in low-risk pregnancies is a generally safe option. However nowadays, only 0.5 percent of deliveries have been at home in Spain. This study sought to understand the characteristics of planned home births with qualified healthcare professionals in low-risk pregnancies and their results on maternal and neonatal health in the Balearic Islands. The study followed a retrospective descriptive design to investigate planned home births from 1989 to 2019 (n = 820). Sociodemographic data of women, healthcare professional intervention rates, and maternal/fetal morbidity/mortality results were collected. Statistical analysis of the results was performed using the IBM SPSS Version 25 software package. The results indicated that women with low-risk pregnancies who planned home births with a qualified midwife had a higher probability of spontaneous vaginal birth delivery and positive maternal health results. Furthermore, the risk of hospital transfer was low (10.7%) and the rate of prolonged breastfeeding (>1 year) was extremely high (99%). Moreover, the study showed that planned home births can be generally associated with fetal well-being. The conclusions and implications of this study are that planned home births in low-risk pregnancies attended by qualified midwives in the Balearic Islands achieve positive results in both maternal and newborn health, as well as low rates of obstetric intervention.
Collapse
Affiliation(s)
- Trinidad M. Galera-Barbero
- Department of Nursing, Physiotherapy and Medicine, Faculty of Health Sciences, University of Almería, 04120 Almería, Spain
- Correspondence:
| | | |
Collapse
|
5
|
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
| |
Collapse
|
6
|
Affiliation(s)
- Alison Hermann
- Psychiatry, NewYork-Presbyterian/Weill Cornell Medical Center, New York
| | - Elizabeth M Fitelson
- Psychiatry, NewYork-Presbyterian/Columbia University Irving Medical Center, New York
| | - Veerle Bergink
- Department of Psychiatry, Icahn School of Medicine at Mount Sinai, New York, New York.,Department of Obstetrics, Gynecology and Reproductive Science, Icahn School of Medicine at Mount Sinai, New York, New York
| |
Collapse
|
7
|
Prehospital Management of Peripartum Neonatal Complications by Helicopter Emergency Medical Service in the South West of the Netherlands: An Observational Study. Air Med J 2020; 39:489-493. [PMID: 33228900 DOI: 10.1016/j.amj.2020.08.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2020] [Revised: 07/23/2020] [Accepted: 08/02/2020] [Indexed: 11/24/2022]
Abstract
OBJECTIVE Emergency medical service (EMS) is responsible for prehospital care encompassing all ages, irrespective of injury cause or medical condition, which includes peripartum emergencies. When patients require care more advanced than the level provided by the national EMS protocol, an EMS physician-staffed Dutch helicopter emergency medical service (HEMS) may be dispatched. In the Netherlands in 2016, there were 21.434 planned home births guided by midwives alone without further obstetric assistance, accounting for 12.7% of all births that year. However, there are no clear data available thus far regarding neonates requiring emergency care with or without HEMS assistance. This article reviews neonates during our study period who received medical care after birth by HEMS. METHODS A retrospective chart review was performed including neonates born on the day of the dispatch between January 2012 and December 2017 who received additional medical care from the Rotterdam HEMS. RESULTS Fifty-two neonates received medical care by HEMS. The majority (73.1%) were full-term (Gestational age > 37 weeks). Home delivery was intended in 63.5%, 20% of whom experienced an uncomplicated delivery but had a poor start of life. The majority of unplanned deliveries (n = 17) were preterm (70.6%). Two were born by resuscitative hysterotomy; 1 survived in good neurologic condition, and the other died at the scene. Fifteen neonates (28.9%) required cardiopulmonary resuscitation; in 2 cases, no resuscitation was started on medical grounds, and 12 of the other 13 resuscitated neonates regained return of spontaneous circulation. In 33 (63.5%) of the neonates, respiratory interventions were required; 8 (15.4%) were intubated before transport. Death was confirmed in 5 (9.6%) neonates, all preterm. CONCLUSION During the study period, 52 neonates required medical assistance by HEMS. The 5 infants who died were all preterm. In this cohort, adequate basic life support was implemented immediately after birth either by the attending midwife, EMS, or HEMS on arrival. This suggests that prehospital first responders know the basic skills of neonatal life support.
Collapse
|
8
|
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.
Collapse
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.
| |
Collapse
|
9
|
Hauck Y, Nathan E, Ball C, Hutchinson M, Somerville S, Hornbuckle J, Doherty D. Women’s reasons and perceptions around planning a homebirth with a registered midwife in Western Australia. Women Birth 2020; 33:e39-e47. [DOI: 10.1016/j.wombi.2018.11.017] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Revised: 11/27/2018] [Accepted: 11/27/2018] [Indexed: 10/27/2022]
|
10
|
Rigg EC, Schmied V, Peters K, Dahlen HG. A survey of women in Australia who choose the care of unregulated birthworkers for a birth at home. Women Birth 2020; 33:86-96. [DOI: 10.1016/j.wombi.2018.11.007] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2018] [Revised: 11/14/2018] [Accepted: 11/16/2018] [Indexed: 01/06/2023]
|
11
|
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.
Collapse
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
| |
Collapse
|
12
|
Satisfaction with obstetric care in a population of low-educated native Dutch and non-western minority women. Focus group research. PLoS One 2019; 14:e0210506. [PMID: 30703116 PMCID: PMC6354976 DOI: 10.1371/journal.pone.0210506] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2018] [Accepted: 12/24/2018] [Indexed: 11/30/2022] Open
Abstract
Background Low-educated native Dutch and non-western minority women have inadequate access to obstetric care. Moreover, the care they receive lacks responsiveness to their needs and cultural competences. Gaining a deeper understanding of their experiences and satisfaction with antenatal, birthing and maternity care will help to adjust healthcare responsiveness to meet their needs during pregnancy, childbirth and the postpartum period. Methods We combined the World Health Organization conceptual framework of healthcare responsiveness with focus group research to measure satisfaction with antenatal, birthing and maternity care of women with a low-educated native Dutch and non-western ethnic background. Results From September 2011 until December 2013, 106 women were recruited for 20 focus group sessions. Eighty-five percent of the women had a non-western immigrant background and 89% a low or intermediate educational attainment. The study population was mostly positive about the provided care during the antenatal phase. They were less positive about the other two phases of care. Moreover, the obstetric healthcare systems’ responsiveness in all phases of care (antenatal, birthing and maternity) did not meet these women’s needs. The ‘respect for persons’ domains ‘autonomy’, ‘communication’ and ‘dignity’ and the ‘client orientation’ domain ‘prompt attention’ were judged most negatively. Conclusions The study findings give contextual meaning and starting points for improvement of responsiveness in the provision of obstetric care within a multi-ethnic women’s population.
Collapse
|
13
|
Davies-Tuck ML, Wallace EM, Davey MA, Veitch V, Oats J. Planned private homebirth in Victoria 2000-2015: a retrospective cohort study of Victorian perinatal data. BMC Pregnancy Childbirth 2018; 18:357. [PMID: 30176816 PMCID: PMC6122533 DOI: 10.1186/s12884-018-1996-6] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Accepted: 08/24/2018] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The outcomes for planned homebirth in Victoria are unknown. We aimed to compare the rates of outcomes for high risk and low risk women who planned to birth at home compared to those who planned to birth in hospital. METHODS We undertook a population based cohort study of all births in Victoria, Australia 2000-2015. Women were defined as being of low or high risk of adverse pregnancy outcomes according to the eligibility criteria for homebirth and either planning to birth at home or in a hospital setting at the at the onset of labour. Rates of perinatal and maternal mortality and morbidity as well as obstetric interventions were compared. RESULTS Three thousand nine hundred forty-five women planned to give birth at home with a privately practising midwife and 829,286 women planned to give birth in a hospital setting. Regardless of risk status, planned homebirth was associated with significantly lower rates of all obstetric interventions and higher rates of spontaneous vaginal birth (p ≤ 0.0001 for all). For low risk women the rates of perinatal mortality were similar (1.6 per 1000 v's 1.7 per 1000; p = 0.90) and overall composite perinatal (3.6% v's 13.4%; p ≤ 0.001) and maternal morbidities (10.7% v's 17.3%; p ≤ 0.001) were significantly lower for those planning a homebirth. Planned homebirth among high risk women was associated with significantly higher rates of perinatal mortality (9.3 per 1000 v's 3.5 per 1000; p = 0.009) but an overall significant decrease in composite perinatal (7.8% v's 16.9%; p ≤ 0.001) and maternal morbidities (16.7% v's 24.6%; p ≤ 0.001). CONCLUSION Regardless of risk status, planned homebirth was associated with significantly lower rates of obstetric interventions and combined overall maternal and perinatal morbidities. For low risk women, planned homebirth was also associated with similar risks of perinatal mortality, however for women with recognized risk factors, planned homebirth was associated with significantly higher rates of perinatal mortality.
Collapse
Affiliation(s)
- Miranda L. Davies-Tuck
- The Ritchie Centre, Hudson Institute of Medical Research, 27-31 Wright Street, Clayton, Vic, 3168 Australia
- Safer Care Victoria, 50 Lonsdale Street, Melbourne, 3000 Australia
| | - Euan M. Wallace
- The Ritchie Centre, Hudson Institute of Medical Research, 27-31 Wright Street, Clayton, Vic, 3168 Australia
- Safer Care Victoria, 50 Lonsdale Street, Melbourne, 3000 Australia
| | - Mary-Ann Davey
- Safer Care Victoria, 50 Lonsdale Street, Melbourne, 3000 Australia
- Department of Obstetrics and Gynaecology, School of Clinical Sciences, Monash University, 246 Clayton Rd, Clayton, Vic, 3168 Australia
| | - Vickie Veitch
- Safer Care Victoria, 50 Lonsdale Street, Melbourne, 3000 Australia
| | - Jeremy Oats
- Consultative Council on Obstetric and Paediatric Mortality and Morbidity (CCOPMM) Department of Health and Human Services, 50 Lonsdale Street, Melbourne, 3000 Australia
| |
Collapse
|