Low-Risk Planned Out-of-Hospital Births: Characteristics and Perinatal Outcomes in Different Italian Birth Settings

Comparison of Frequency of Home Births in the Member States of the EU Between 2015 and 2019

Introduction. The disagreement of the general public’s views on home births is practically identical for the professional public and specialists also. The core of the problem lies in the disunity between individual countries of the European Union—complete prohibition under the risk of committing a crime on one side and standard procedure perceived as something completely common on the other side. Methods. The authors focused on the prevalence of home births in individual EU countries, together with the proportion of neonatological mortality compared to the number of live births, which are data that, unlike home births, are mandatory in each EU Member State. Data on home births were obtained from available official and verified sources such as the Ministry of Health, reviews published by the WHO, or published peer-reviewed scientific and professional works. Secondary data were procured via Web of Science, Scopus, or PubMed. Results. The aim of the study was to trace the documented numbers of home births in the individual states of the European Union in the years 2015 to 2019, to analyze them with data on live births together and with data on infant mortality. A comparative analysis of the compiled data can be used to conclude which countries have the highest domestic birth rates and how the birth rate is manifested in these countries. Based on the analysis of available data, it can be determined that the Netherlands, Denmark, and Germany have the highest share of domestic births. The link between home births and increased neonatal mortality has not been established. Eastern Europe countries have the highest neonatal mortality, namely Romania (1.19%) and Malta (0.63%). Conclusion. The Netherlands has the highest domestic birth rate per 100 000 inhabitants with a 5-year average of 161 922 (overall average of all live births 993.40), but is also in 11th place in neonatal mortality, together with Denmark and Belgium, which have 0.35% neonatal neonatal mortality. The country with the lowest neonatal mortality of 0.19% is Slovenia. The total average of all children born in 5 years (915 live births) is 1.422. When monitoring the number of domestic births in other countries in the years 2015 to 2019, an increasing tendency of this trend is observed.

Cost analysis of planned out-of-hospital births in Italy

BACKGROUND AND AIM

In Italy, the main birthplace is a hospital, and only a few women choose an out-of-hospital setting. This study assessed the costs related to delivery in different birthplaces in Italy.

METHODS

The cost analysis considered direct and amortizable costs associated with mother-child care in physiological conditions. An analysis of the hospital births considered the Diagnoses-Related Groups 373 and 391. To estimate the cost of the births assisted privately by freelance midwives, an evaluation based on an experts' opinion was carried out.

RESULTS

Childbirth hospital care in Italy amounts to € 1832.00, and birth in an out-of-hospital setting accredited with the National Health System has a full cost of € 1345.19 in the 'maternity home' and € 909.60 at home. The average cost of the birth in 'private maternity homes' amounted to € 3260.00, while at-home births amounted to € 2910.00.

CONCLUSIONS

Any accreditation of out-of-hospital settings by the NHS would considerably reduce the waste of economic resources compared to hospital childbirth.

MYNd&CO (Mindfulness, Yoga, Nutrition, development & Coaching, and Osteopathy) randomized controlled trial for a positive psychophysical experience in pregnancy and after birth: a study protocol

BACKGROUND AND AIM

The medicalisation of birth pathway may negatively impact on women's empowerment, enhancing distress even in cases of healthy pregnancies. We have built a program which is comprised of Mindfulness, Yoga, Nutrition, development & Counselling, Coaching, antenatal classes, and Osteopathic treatment (MYNd&CO).

METHODS

This study is a randomized controlled trial involving low-risk pregnant women. They will be randomized to the experimental (MYNd&CO intervention plus standard care) or control group (standard care). The primary (general health and wellbeing, maternal distress) and secondary outcome measures (urinary incontinence, sexual problems, and physical wellbeing) will be assessed via questionnaires at baseline and 6 months after childbirth. The independent-samples t-test and Chi-square will be used to detect changes in the outcomes between intervention and control group.

DISCUSSION

The trial is expected to increase knowledge about the effectiveness of a holistic approach in low-risk pregnant women, in terms of obstetrical and psychophysiological outcomes.