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Luettelo
synnytyspaikkaan ja kotisynnytyksiin liittyvistä tutkimuksista
- Artikkelit aakkostettu tekijän mukaan.
- Koonnut Hanna Hirvonen
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Abel S. Kearns RA.
Birth places:
a geographical perspective on planned home birth in New Zealand
Social
Science & Medicine. 33(7):825-34, 1991.
In New Zealand until the 1920s, most births occurred at home or in small
maternity hospitals under the care of a midwife. Births subsequently came under
the control of the medical profession and the prevalent medical ideology
continues to support hospitalised birth in the interests of safety for mother
and child. Despite resistance from the medical profession, recent (1990)
legislation has reinstated the autonomy of midwives and this has come at a time
when the demand for home births is increasing. This paper locates these changes
within the geographical context of home as a primary place within human
experience. It is argued that the medical profession has been an agent of an
essentially patriarchal society in engendering particular experiences of time
and place for women in labour. Narrative data indicate that the choice of home
as a birth place is related to three dimensions of experience unavailable in a
hospital context: control, continuity and the familiarity of home.
Aikins Murphy P,
Feinland JB
Perineal outcomes in a home birth setting.
Birth 1998 Dec;25(4):226-34
BACKGROUND: Perineal lacerations are a source of significant discomfort to many
women. This descriptive study examined perineal outcomes in a home birth
population, and provides a preliminary description of factors associated with
perineal laceration and episiotomy. METHODS: Data were drawn from a prospective
cohort study of 1404 intended home births in nurse-midwifery practices. Analyses
focused on a subgroup of 1068 women in 28 midwifery practices who delivered at
home with a midwife in attendance. Perineal trauma included both episiotomy and
lacerations. Minor abrasions and superficial lacerations that did not require
suturing were included with the intact perineum group. Associations between
perineal trauma and study variables were examined in the pooled dataset and for
multiparous and nulliparous women separately. RESULTS: In this sample 69.6
percent of the women had an intact perineum, 15 (1.4%) had an episiotomy, 28.9
percent had first- or second-degree lacerations, and 7 women (0.7%) had third-
or fourth-degree lacerations. Logistic regression analyses showed that in
multiparas, low socioeconomic status and higher parity were associated with
intact perineum, whereas older age (>/= 40 yr), previous episiotomy, weight gain
of over 40 pounds, prolonged second stage, and the use of oils or lubricants
were associated with perineal trauma. Among nulliparas, low socioeconomic
status, kneeling or hands-and-knees position at delivery, and manual support of
the perineum at delivery were associated with intact perineum, whereas perineal
massage during delivery was associated with perineal trauma. CONCLUSIONS: The
results of this study suggest that it is possible for midwives to achieve a high
rate of intact perineums and a low rate of episiotomy in a select setting and
with a select population.
Anderson R. Greener D
A descriptive analysis of home births attended by CNMs in two nurse-midwifery
services
Journal of Nurse-Midwifery. 36(2):95-103, 1991 Mar-Apr.
This study examined outcome data from two nurse-midwifery operated home birth
services in Texas. All clients who planned a home birth within the two services
during 1987 comprised the population. Analyses revealed that women choosing home
birth with these nurse-midwives were more frequently married, usually white, and
more educated when compared with the overall U.S. childbearing population.
Analgesia, episiotomy, and cesarean delivery were all found at lower rates than
is reported when birth occurs in a hospital setting; complications occurred less
frequently or at similar rates to those reported in the home birth literature
and national statistics. Research, educational, and clinical implications of the
study are discussed.
Anderson RE, Murphy
PA
Outcomes of
11,788 planned home births attended by certified nurse-midwives. A retrospective
descriptive study.
J Nurse Midwifery 1995
Nov-Dec;40(6):483-92
This study describes the outcomes of 11,788 planned home births attended by
certified nurse-midwives (CNMs) from 1987 to 1991. A retrospective survey was
used to obtain information about the outcomes of intended home birth, including
hospital transfers, as well as practice protocols, risk screening, and emergency
preparedness. Ninety nurse-midwifery home birth practices provided data for this
report (66.2% of identified nurse-midwifery home birth practices). It is
estimated that 60-70% of all CNM-attended home births reported in national
statistics data during this period were represented in this survey. The overall
perinatal mortality was 4.2 per 1,000, including known third-trimester fetal
demises. There were no maternal deaths. The intrapartum and neonatal mortality
for those intending home birth at the onset of labor was 2 per 1,000; the
overall neonatal mortality rate for this group was 1.3 per 1,000. When deaths
associated with congenital anomalies were excluded, the intrapartum and neonatal
mortality rate was 0.9 per 1,000; the neonatal mortality was 0.2 per 1,000. The
overall transfer rate, including antepartum referrals, was 15.9%. The
intrapartum transfer rate for those intending home birth at the onset of labor
was 8%. Most responding nurse-midwives used standard risk-assessment criteria,
only delivered low-risk women at home, and were prepared with emergency
equipment necessary for immediate neonatal resuscitation or maternal
emergencies. This study supports previous research indicating that planned home
birth with qualified care providers can be a safe alternative for healthy lower
risk women.
Anderson RE. Anderson
DA.
The
cost-effectiveness of home birth.
Journal of
Nurse-Midwifery. 44(1):30-5, 1999 Jan-Feb.
As health care costs increase and a growing number of women are without
insurance, the one health service that every family needs deserves further
attention. Even for the 40% of births covered by Medicaid, safe birthing
alternatives that permit a reduction in the $150 billion Medicaid burden would
allow the United States to devote more resources to other urgent priorities.
Informed birthing decisions cannot be made without information on costs, success
rates, and any necessary tradeoffs between the two. This article provides the
relevant information for hospital, home, and birth center births. The average
uncomplicated vaginal birth costs 68% less in a home than in a hospital, and
births initiated in the home offer a lower combined rate of intrapartum and
neonatal mortality and a lower incidence of cesarean delivery.
Chamberlain G,
Wraight A, Crowley P
Birth at home. Pract Midwife 1999 Jul-Aug;2(7):35-9
Recently the National Birthday Trust performed a confidential survey of home
births in the United Kingdom. A good response rate was obtained from midwives,
who recruited two groups of women prospectively; those planned and accepted as
suitable for a home delivery at 37 weeks and a matched group of similar women
who were booked for hospital by 37 weeks. Some 16% of such women were
transferred to hospital in late pregnancy (4%) or in labour (12%). This figure
rose to 40% among the primiparous women in the survey. The survey report
presents an analysis of 4,500 home births and 3,300 hospital controls. Outcomes
could therefore be presented by the woman's intent or by what actually happened.
In essence it seems that a woman who is appropriately selected and screened for
a home birth is putting herself and her baby at no greater risk than a mother of
a similar low-risk profile who is hospital booked and delivered. Home births
will probably increase to 4-5% of all maternities in UK during the next decade
and this needs preparatory planning.
Albers LL. Katz VL.
Birth setting
for low-risk pregnancies. An analysis of the current literature
Journal of
Nurse-Midwifery. 36(4):215-20, 1991 Jul-Aug.
This article reviews the literature on birth settings for women with low-risk
pregnancies. Methodological issues of the existing research include nonrandom
designs, small samples, selection differences, data limitation, and confounding
bias. Studies for four birth sites are summarized: the home, freestanding birth
centers, in-hospital birthing centers or birthing rooms, and traditional
hospital settings. Despite the methodological limitations, nontraditional birth
settings present advantages for low-risk women as compared with traditional
hospital settings: lower costs for maternity care, and lower use of childbirth
procedures, without significant differences in perinatal mortality. [References:
57]
Chamberlain M. Soderstrom B. Kaitell C. Stewart P
Consumer interest in alternatives to physician-centred hospital birth in
Ottawa Midwifery. 7(2):74-81, 1991 Jun.
A survey of 1109 women who delivered in a hospital or at home in a major city in
Canada was conducted. The women were asked to respond to questions concerning
the type of health professional they would like to provide reproductive care.
The choices they were offered were: midwife, obstetrician, general practitioner
or nurse, or a combination. Respondents were also asked to identify if they had
an interest in an alternative such as a birthing room, birthing centre or home
birth, to hospital labour ward care. Almost 60% of women were interested in some
form of midwifery care with the major emphasis placed on counselling and
support. Of the women who expressed an interest in midwifery services a large
number elected for that service to be shared with an obstetrician. Women who
were older and had achieved a high level of education were more interested in
midwifery services than other women. If given choices of a hospital labour,
birthing room, birthing centre or home birth 53% of women would choose to give
birth in a hospital labour ward. A major reason for this choice was the
accessibility of epidural analgesia. The majority of women who had experienced a
home birth would make the same choice again. There was a strong positive
association between interest in using midwifery services and interest in a
birthing centre and home birth.
Cunningham JD. Experiences of Australian mothers who gave birth either at
home, at a birth centre, or in hospital labour wards Social Science &
Medicine. 36(4):475-83, 1993 Feb.
In order to compare their antenatal education levels, reasons for choosing the
birthplace, experiences during labor and childbirth, analgesia, satisfaction
with birth attendants and others present, and related attitudes 395 Sydney-area
mothers were recruited within one year of giving birth. Five sources were used
to obtain mail-questionnaire responses from 239 who gave birth in a hospital
labor ward, 35 at a birth centre, and 121 who chose to give birth at home.
Homebirth mothers were older, more educated, more feminist, more willing to
accept responsibility for maintaining their own health, better read on
childbirth, more likely to be multiparous, and gave higher rating of their
midwives than labour-ward mothers, with birth-centre mothers generally scoring
between the other two groups. As well, homebirth and birth-centre mothers were
more likely to feel the birthplace affected the bonding process and were less
likely to regard birth as a medical condition than labour-ward mothers. In
regression analysis birth venue (among other variables) significantly predicted
satisfaction with doctor, if present during labour and delivery, and five
variables correlated with birth venue significantly predicted satisfaction with
midwife, husband/partner, and other support person. Findings are discussed in
the light of the current struggle between medical and 'natural' models of
childbirth.
De Reu PA, Nijhuis JG,
Oosterbaan HP, Eskes TK. Perinatal audit on avoidable mortality in a Dutch
rural region: A retrospektive study. Eur. J Obstet Gynecol Reprod Biol 2000
Jan; 88 (1):65-9
OBJECTIVE: To analyse
the mode and cause of perinatal mortality. SETTING: a rural Dutch region. STUDY
DESIGN: Over a two-year period (1994-1995), data were collected in the 's
Hertogenbosch region. A perinatal audit group investigated and classified the
cause of death in an "intention to treat" and concensus model. We then analyzed
who was responsible for the patient at the moment perinatal death occurred, or
became inevitable. RESULTS: Out of 8509 newborns, 73 died between the 24th week
of pregnancy till the 7th day post-partum (8.58 promille). Twenty-three cases
(31.50%) were classified as probably or possibly avoidable. In the primary
health care group (midwives, general practitioners) 6 out of 32 (18.75%), in the
secondary care group (obstetricians) 15 out of 35 (44.86%) and in the tertiary
care group 1 out of 4 (25.00%) were judged as probably or possibly avoidable.
The degree of concensus in the perinatal audit committee was high (Kappa=0.9).
IMPACT: The analysis of perinatal mortality identifies the cause of death and
may help to improve perinatal health care. CONCLUSION: In this study, 31.55% of
perinatal mortality was avoidable in the three levels of care. Intra-uterine
growth retardation, congenital malformations and antepartum haemorrhage were the
most determinant factors for perinatal mortality. The Dutch obstetrical care
system as such, for example home deliveries, did not effect the perinatal
mortality rate. Perinatal mortality rates presented by the Dutch Central Bureau
of Statistics still shows a slight underregistration.
Duran AM.
The safety of home birth: the farm study American Journal of Public
Health. 82(3):450-3, 1992 Mar.
Pregnancy outcomes of 1707 women, who enrolled for care between 1971 and 1989
with a home birth service run by lay midwives in rural Tennessee, were compared
with outcomes from 14,033 physician-attended hospital deliveries derived from
the 1980 US National Natality/National Fetal Mortality Survey. Based on rates of
perinatal death, of low 5-minute Apgar scores, of a composite index of labor
complications, and of use of assisted delivery, the results suggest that, under
certain circumstances, home births attended by lay midwives can be accomplished
as safely as, and with less intervention than, physician-attended hospital
deliveries.
Eskes TK.
Home deliveries in The Netherlands--perinatal mortality and morbidity
International Journal of Gynaecology & Obstetrics. 38(3):161-9, 1992 Jul.
The obstetrical organizational system in the Netherlands is based on the
selection for risk factors. We conclude that: (i) The reporting of perinatal
death is not complete. (ii) Perinatal mortality can be reduced. (iii) More
iatrogenic interventions are present in low-risk deliveries in hospitals. (iv)
Neurological behavior of low-risk babies born at home is equal to those born at
the hospital, despite the worse maternal profile of the latter and the level of
acidemia at birth in the first. Good data especially in referred cases are
necessary before adopting a similar system.
Ford C. Iliffe S. Franklin O.
Outcome of planned home births in an inner city
practice
BMJ. 303(6816):1517-9, 1991 Dec 14.
OBJECTIVE--To assess the outcome of pregnancy for women booking for home births
in an inner London practice between 1977 and 1989. DESIGN--Retrospective review
of practice obstetric records. SETTING--A general practice in London.
SUBJECTS--285 women registered with the practice or referred by neighbouring
general practitioners or local community midwives. MAIN OUTCOME MEASURES--Place
of birth and number of cases transferred to specialist care before, during, and
after labour. RESULTS--Of 285 women who booked for home births, eight left the
practice area before the onset of labour, giving a study population of 277
women. Six had spontaneous abortions, 26 were transferred to specialist care
during pregnancy, another 26 were transferred during labour, and four were
transferred in the postpartum period. 215 women (77.6%, 95% confidence interval
72.7 to 82.5) had normal births at home without needing specialist help.
Transfer to specialist care during pregnancy was not significantly related to
parity, but nulliparous women were significantly more likely to require transfer
during labour (p = 0.00002). Postnatal complications requiring specialist
attention were uncommon among mothers delivered at home (four cases) and rare
among their babies (three cases). CONCLUSIONS--Birth at home is practical and
safe for a self selected population of multiparous women, but nulliparous women
are more likely to require transfer to hospital during labour because of delay
in labour. Close cooperation between the general practitioner and both community
midwives and hospital obstetricians is important in minimising the risks of
trial of labour at home.
Fullerton JT, Severino R.
In-hospital care for low-risk childbirth. Comparison with results from the National Birth Center Study. J Nurse Midwifery 1992 Sep-Oct;37(5):331-40
The largest prospective study of freestanding birth centers was reported in 1989. This article reports on data from a comparison group of over 2,000 low-risk women who were admitted to hospital-care settings during the same period. The data on the hospitalized women were collected using the research methodology and data collection instruments developed for the birth center study. Consequently, these data offer the opportunity to observe differences that can be associated with birth site. Both groups of women experienced similar rates of serious antepartum and intrapartum health problems and maternal morbidity. However, even when controlling for complications and differences in sociodemographic characteristics, women in hospitals were more likely to receive
an interventive style of labor and birth management. Neonatal outcomes were also similar, although the incidence of sustained fetal distress, prolapsed cord, and difficulty in establishing respirations were significantly greater in the hospital sample. Hospital care did not offer any advantage for women at lowest risk, and it was associated with increased intervention. The results of this
study provide support for the National Birth Center Study's conclusion that birth centers offer a safe and acceptable alternative for selected pregnant women.
Hafner-Eaton C.
Pearce LK. Birth choices, the law, and medicine: balancing individual
freedoms and protection of the public's health. Journal of Health Politics,
Policy & Law. 19(4):813-35, 1994 Winter.
To many Americans, the idea of home birth, the use of a "direct-entry midwife,"
or both seem archaic. Although much of the professional medical community
disapproves of either, state laws regarding birth choices vary dramatically and
are not necessarily based on empirical findings of childbirth outcomes. Public
health practitioners, policymakers, and consumers view childbirth from the
perspectives of safety, cost, freedom of choice, quality of the care experience,
and legality, yet the professional, policy, and lay literatures have not offered
an unemotional, balanced presentation of evidence. Reviewing the full spectrum
of literature from the United States and abroad, we present a Constitutional
medical-legal analysis of whether home birth with direct-entry midwives is in
fact a safe alternative to physician-attended hospital births, and whether there
is a legal basis for allowing alternative health policy choices is such an
important yet personal family matter as childbirth. The literature shows that
low- to moderate-risk home births attended by direct-entry midwives are at least
as safe as hospital births attended by either physicians or midwives. The policy
ramifications include important changes in state regulation of medical and
alternative health personnel, the allowance of the home as a medically
acceptable and legal birth setting, and reimbursement of this lower-cost option
through private and public health insurers.
Janssen PA. Holt VL.
Myers SJ Licensed midwife-attended, out-of-hospital births in Washington
state: are they safe? Birth. 21(3):141-8, 1994 Sep.
The safety of out-of-hospital births attended by midwives who are licensed
according to international standards has not been established in the United
States. To address this issue, outcomes of births attended out of hospital by
licensed midwives in Washington state were compared with those attended by
physicians and certified nurse-midwives in hospital and certified nurse-midwives
out of hospital between 1981 and 1990. Outcomes measured included low
birthweight, low five-minute Apgar scores, and neonatal and postneonatal
mortality. Associations between attendant and outcomes were measured using odds
ratios to estimate relative risks. Multivariate analysis using logistic
regression controlled for confounding variables. Overall, births attended by
licensed midwives out of hospital had a significantly lower risk for low
birthweight than those attended in hospital by certified nurse-midwives, but no
significant differences were found between licensed midwives and any of the
comparison groups on any other outcomes measured. When the analysis was limited
to low-risk women, certified nurse-midwives were no more likely to deliver low-birthweight
infants than were licensed midwives, but births attended by physicians had a
higher risk of low birthweight. The results of this study indicate that in
Washington state the practice of licensed nonnurse-midwives, whose training
meets standards set by international professional organizations, may be as safe
as that of physicians in hospital and certified nurse-midwives in and out of
hospital.
Kenny P. King MT. Cameron S. Shiell A
Satisfaction with postnatal care--the
choice of home or hospital Midwifery. 9(3):146-53, 1993 Sep.
This paper reports the findings of a study of client satisfaction with postnatal
midwifery care. Women could choose one of two forms of care; either domiciliary
care following early discharge, or hospital care until discharge. Consumers'
perceptions of their postnatal care were examined at the end of the period of
care. Women assessed the midwives' interest and caring, education and
information provided, their own progress with feeding and baby care, and their
own physical and emotional health. They were also asked about their expectations
of and gains from postnatal care. The findings indicated that women choosing
domiciliary care and women choosing hospital care had different expectations of
their postnatal care, but were largely satisfied with the quality of the care
they chose. The women who chose domiciliary care rated their postnatal care more
highly than the women who stayed in hospital. The findings reinforce the
importance of providing women with choices for the maternity care which best
suits their needs
Kerssens, J. J.
Patient
satisfaction with home-birth care in The Netherlands.
Journal of Advanced Nursing 20(4), 1994: 344-50.
One of the necessary elements in an obstetric system of home confinements is
well-organized postnatal home care. In The Netherlands home care assistants
assist midwives during home delivery, they care for the new mother as well as
the newborn baby, instruct the family on infant health care and carry out
household duties. The growing demand for postnatal home care is difficult to
meet; this has resulted in a short supply of the most popular day care programme
and a level of provision which does not result in adequate services. This study
acknowledges the patient perspective of maternity home care in order to
contribute to its organization. The majority (79%) of service centres were
willing to participate. A total of 1812 (81%) women who recently gave birth to a
child responded to a postal questionnaire addressing the quality of care
according to five dimensions: availability, continuity, interpersonal
relationships, outcome and assistant's expertise. Almost one-third of the new
mothers rated the availability as inadequate while the assistant's expertise was
rated positively. Postnatal maternity home care is personalized, small-scale,
and recognizes childbirth as a life event. Furthermore, it is relatively
inexpensive and contributes to the satisfaction of recipients.
Kleiverda G. Steen AM.
Andersen I.
Treffers PE. Everaerd W.
Place of delivery in The Netherlands: actual
location of confinement
European Journal of Obstetrics, Gynecology, & Reproductive Biology.
39(2):139-46, 1991 Apr 16.
Preferred and actual locations of confinement were compared in a group of 170
nulliparous women. Voluntary changes in preferred location for birth were rare
and concerned only changes from hospital to home confinement. Obligatory changes
due to referral to consultant obstetricians occurred frequently: 58.8% of the
total sample. Fewer referrals were found for women with an initial preference
for a home confinement (53%) than for those who preferred a hospital confinement
(64%). Most referrals occurred in the group of older women initially in doubt
about their preferred location for giving birth: 72%. The differences were not
significant, however. To reveal differences between referrals and non-referrals,
discriminant analysis was performed at the 18th week of gestation. The explained
variance for the total group of referrals was 64.7%. Partially, the variables
pertaining to the explained variance were the same as those related to a
preferred hospital confinement. The explained variance for the group of
referrals in which psychosocial influences were presupposed was not better, with
the exception of referrals due to insufficient progress during labour: 76.4% of
the variance could be explained at the 34th gestational week. When birth weight
and amenorrhoea were included, these percentages increased to 79.0 and 84.8%,
respectively.
MacVicar J. Dobbie
G. Owen-Johnstone L. Jagger C. Hopkins M. Kennedy J.
Simulated home delivery in hospital: a randomised controlled trial British Journal of Obstetrics &
Gynaecology. 100(4):316-23, 1993 Apr.
OBJECTIVES: To compare the outcome of two methods of maternity care during the
antenatal period and at delivery. One was to be midwife-led for both antenatal
care and delivery, the latter taking place in rooms similar to those in one's
own home to simulate home confinement. The other would be consultant-led with
the mothers labouring in the delivery suite rooms with resuscitation equipment
for both mother and baby in evidence, monitors present and a delivery bed on
which both anaesthetic and obstetric procedures could be easily and safely
carried out. DESIGN: Randomised controlled trial. SETTING: Leicester Royal
Infirmary Maternity Hospital. SUBJECTS: Of 3510 women who were randomised, 2304
were assigned to the midwife-led scheme and 1206 were assigned to the
consultant-led scheme. MAIN OUTCOME MEASURES: Complications in the antenatal,
intrapartum and postpartum periods were compared as was maternal morbidity and
fetal mortality and morbidity. Satisfaction of the women with care over
different periods of the pregnancy and birth were assessed. RESULTS: There were
few significant differences in antepartum, intrapartum and postpartum events
between the two groups. There was no difference in the percentage of mothers and
babies discharged home alive and well. Generally higher levels of satisfaction
with care antenatally and during labour and delivery were shown in those women
allocated to midwife care.
Murphy PA. Fullerton
J.
Outcomes of intended home births in nurse-midwifery practice: a prospective
descriptive study.Obstetrics & Gynecology. 92(3):461-70, 1998 Sep.
OBJECTIVE: To describe the outcomes of intended home birth in the practices of
certified nurse-midwives. METHODS: Twenty-nine US nurse-midwifery practices were
recruited for the study in 1994. Women presenting for intended home birth in
these practices were enrolled in the study from late 1994 to late 1995. Outcomes
for all enrolled women were ascertained. Validity and reliability of submitted
data were established. RESULTS: Of 1404 enrolled women intending home births, 6%
miscarried, terminated the pregnancy or changed plans. Another 7.4% became
ineligible for home birth prior to the onset of labor at term due to the
development of perinatal problems and were referred for planned hospital birth.
Of those women beginning labor with the intention of delivering at home, 102
(8.3%) were transferred to the hospital during labor. Ten mothers (0.8%) were
transferred to the hospital after delivery, and 14 infants (1.1%) were
transferred after birth. Overall intrapartal fetal and neonatal mortality for
women beginning labor with the intention of delivering at home was 2.5 per 1000.
For women actually delivering at home, intrapartal fetal and neonatal mortality
was 1.8 per 1000. CONCLUSION: Home birth can be accomplished with good
outcomes under the care of qualified practitioners and within a system that
facilitates transfer to hospital care when necessary. Intrapartal mortality
during intended home birth is concentrated in postdates pregnancies with
evidence of meconium passage.
Olsen O.
Home delivery and scientific reasoning Source Tidsskrift for
Den Norske Laegeforening. 114(30):3655-7, 1994 Dec 10.
Doctors commonly assume that it is safer for all women to give birth in hospital
rather than at home. Nevertheless, all statistical comparisons relevant to
Nordic women today show that for healthy pregnant women it is at least as safe
to give birth at home--and perhaps even safer. Furthermore, many randomised
clinical trials consistently show that several of the elements which
characterize home births make the births proceed much easier. The question is
raised, in what ways it is possible to convince obstetricians that they should
base their judgements and advice regarding place of birth on empirical evidence
rather than on "well established" but pre-scientific dogmas.
Olsen O.
Meta-analysis of the safety of home birth.
Birth 1997
Mar;24(1):4-13; discussion 14-6
BACKGROUND: The safety of planned home birth is controversial. This study
examined the safety of planned home birth backed up by a modern hospital system
compared with planned hospital birth in the Western world. METHODS: A
meta-analysis of six controlled observational studies was conducted, and the perinatal outcomes of 24,092 selected and primarily low-risk pregnant women were
analyzed to measure mortality and morbidity, including Apgar scores, maternal
lacerations, and intervention rates. Confounding was controlled through
restriction, matching, or in the statistical analysis. RESULTS: Perinatal
mortality was not significantly different in the two groups (OR = 0.87, 95% Ci
0.54-1.41). The principal difference in the outcome was a lower frequency of low
Apgar scores (OR = 0.55; 0.41-0.74) and severe lacerations (OR = 0.67;
0.54-0.83) in the home birth group. Fewer medical interventions occurred in the
home birth group: induction (statistically significant ORs in the range
0.06-0.39), augmentation (0.26-0.69), episiotomy (0.02-0.39), operative vaginal
birth (0.03-0.42), and cesarean section (0.05-0.31). No maternal deaths occurred
in the studies. Some differences may be partly due to bias. The findings
regarding morbidity are supported by randomized clinical trials of elements of
birth care relevant for home birth, however, and the finding relating to
mortality is supported by large register studies comparing hospital settings of
different levels of care. CONCLUSION: Home birth is an acceptable alternative to
hospital confinement for selected pregnant women, and leads to reduced medical
interventions.
Sakala C.
Midwifery care and out-of-hospital birth settings: how do they
reduce unnecessary cesarean section births? Social Science & Medicine.
37(10):1233-50, 1993 Nov.
In studies using matched or adjusted cohorts, U.S. women beginning labor with
midwives and/or in out-of-hospital settings have attained cesarean section rates
that are considerably lower than similar women using prevailing forms of
care--physicians in hospitals. This cesarean reduction involved no compromise in
mortality and morbidity outcome measures. Moreover, groups of women at elevated
risk for adverse perinatal outcomes have attained excellent outcomes and
cesarean rates well below the general population rate with these care
arrangements. How do midwives and out-of-hospital birth settings so effectively
help women to avoid unnecessary cesareans? This paper explores this question by
presenting data from interviews with midwives who work in home settings. The
midwives' understanding of and approaches to major medical indications for
cesarean birth contrast strikingly with prevailing medical knowledge and
practice. From the midwives' perspective, many women receive cesareans due to
pseudo-problems, to problems that might easily be prevented, or to problems that
might be addressed through less drastic measures. Policy reports addressing the
problem of unnecessary cesarean births in the U.S. have failed to highlight the
substantial reduction in such births that may be expected to accompany greatly
expanded use of midwives and out-of-hospital birth settings. The present
study--together with cohort studies documenting such a reduction, studies
showing other benefits of such forms of care, and the increasing reluctance of
physicians to provide obstetrical services--suggests that childbearing families
would realize many benefits from greatly expanded use of midwives and
out-of-hospital birth settings.
- STAKESin tiedoite
Nro 2/10.1. 2001
Kotisynnytys kiinnostaa, mutta valitaan harvoin
Suomalaiset naiset valitsevat synnytyspaikaksi sairaalan, mutta myös
polikliiniset ja kotisynnytykset kiinnostavat heitä. Tuoreen väitöstutkimuksen
mukaan kiinnostus johtaa kuitenkin harvoin vaihtoehtoisen synnytystavan
valintaan. Suurin osa naisista luottaa terveydenhuoltojärjestelmän tarjoamiin
vaihtoehtoihin. Suomalaiset kotisynnyttäjät epäilevät, pystyykö
synnytyssairaala tarjoamaan sellaista ympäristöä, jossa nainen itse voisi
hallita omaa synnytysprosessiaan.
- Stakesin tutkijan
Kirsi Viisaisen synnytyshoidon valintoja käsittelevä väitöskirja tarkastetaan
Helsingin yliopiston lääketieteellisessä tiedekunnassa lauantaina 13.1.2001.
Kansanterveystieteen alaan kuuluvassa tutkimuksessa tarkastellaan
synnytyspaikan määräytymistä ja hoidon tuloksia sekä asiakkaan että
terveydenhuoltojärjestelmän näkökulmasta. Se perustuu valtakunnalliseen
väestökyselyyn, kotisynnytyksen valinneiden vanhempien teemahaastatteluihin
sekä syntymärekisteri- ja tilastotietoihin.
- Haastattelujen
mukaan kotisynnytyspäätös merkitsee vanhemmille riskien kartoitusta: Vanhemmat
ottavat huomioon paitsi lääketieteelliset riskit, myös muut heille tärkeät
riskit, kuten sairaalaympäristön aiheuttamat ongelmat, sekä auktoriteetin
vastustamiseen liittyvän moraalisen riskin.
- Tutkimus osoittaa,
että synnytyssairaalaverkoston harveneminen ei ole ollut ongelmatonta, sillä
riski joutua synnyttämään sairaalan ulkopuolella näyttää lisääntyneen
erityisesti harvaanasutuilla seuduilla. Pohjoissuomalaisille synnyttäjille
riski oli 1990-luvulla 2,5-kertainen verrattuna eteläsuomalaisiin. Sairaalan
ulkopuolisia suunnittelemattomia synnytyksiä oli 1990-luvulla koko maassa yksi
tuhannesta.
-
Syntymäkuolleisuudella mitattuna myös pienet synnytyssairaalat ovat
turvallisia synnytyspaikkoja suomalaisessa porrastetussa järjestelmässä.
Niiden turvallisuutta ei kuitenkaan voi määritellä yksittäisen sairaalan
tasolla, vaan osana koko järjestelmää. Syntymäkuolleisuudessa ei ilmennyt
eroja alue-, keskus- tai yliopistosairaaloiden vastuualueiden välillä.
Viisainen
K.
Negotiating control and meaning: home birth as a
self-constructed choice in Finland. Soc Sci Med
2001 Apr;52(7):1109-21
Each society has its own consensual understanding of birth and its determinants:
caregivers, location, participants and loci of decision-making, which in the
Western world are based on biomedical knowledge. However, two competing cultural
models of childbirth, the biomedical/technocratic model and natural/holistic
model, mediate women's choices and preferences for the place and caregiver in
childbirth. This article explores the way in which these cultural models of
birth and the existing practical possibilities for choices shape women's and
men's understanding of home birth. Based on interviews with 21 Finnish women and
12 Finnish men, the reasons for and experiences of planning and building toward
a home birth are examined through an analysis of birth narratives. The analysis
focuses especially on the women's definitions of what is 'natural' and their
relationship with health services where biomedical practices and knowledge are
the norm. The analysis shows that the notion of 'natural birth' holds various
meanings in Finnish women's narratives namely self-determination, control, and
trust in one's intuition. I seek to demonstrate that just as the biomedical
management of childbirth exhibits distinct cross-cultural variation, so also
does resistance to biomedical hegemony, as such resistance is strongly embedded
in the local socio-cultural situation.
Viisainen K.
Choices in Birth Care - the Place of Birth (Synnytyshoidon valintoja - missä voi
synnyttää), Stakes, Research Report 115, Helsinki 2000. The choice of place
of birth is not only a question of health services resource allocation but also
an issue of individual choice, power relations between professions and status of
professional knowledge. This thesis is a crossdisciplinary study about the place
of birth in the Finnish health care system. The health outcomes of birth care at
different hospital levels in Finland are evaluated using a catchment area based
analysis. The centralisation of birth care and the parallel incidence of
out-of-hospital births are examined using data from historical statistics and
the medical birth register. Client views on place of birth are examined at a
general level through a nationwide survey and more specifically through
interviews of parents who chose home birth. A review of comparative studies of
places of birth in other Western countries and a review of the social sciences'
literature on cultural and social issues about the place of birth are provided.
The historical development of the transition of birth care into hospitals in
Finland is also reviewed.
Wiegers TA. van der Zee
J. Keirse MJ.
Maternity care in The Netherlands: the changing home birth rate.
Birth. 25(3):190-7, 1998
Sep.
In 1965 two-thirds of all births in The Netherlands occurred at home. In the
next 25 years, that situation became reversed with more than two-thirds of
births occurring in hospital and fewer than one-third at home. Several factors
have influenced that change, including the introduction of short-stay hospital
birth, hospital facilities for independent midwives, increased referral rates
from primary to secondary care, changes in the share of the different
professionals involved in maternity care, medical technology, and demographic
changes. After a decline up to 1978 and a period of relative stability between
1978 and 1988, the home birth rate started to decline further, to the extent
that it might destabilize the Dutch maternity care system and the role of
midwives in it. The Dutch maternity care system depends heavily on primary
caregivers, midwives and general practitioners who are responsible for the care
of women with low-risk pregnancies, and on obstetricians who provide care for
high-risk pregnancies. Its preservation requires a high level of cooperation
among the different caregivers, and a functional selection system to ensure that
all women receive the type of care that is best suited to their needs.
Preserving the home birth option in the Dutch maternity care system necessitates
the maintenance of high training and postgraduate standards for midwives, the
continued provision of maternity home care assistants, and giving women with
uncomplicated pregnancies enough confidence in themselves and the system to feel
safe in choosing a home birth.
Woodcock HC. Read AW.
Bower C. Stanley FJ. Moore DJ
A matched cohort study of planned home and
hospital births in Western Australia 1981-1987 Midwifery. 10(3):125-35, 1994
Sep.
OBJECTIVE: to evaluate practice comparing planned home birth with planned
hospital birth DESIGN: a retrospective analysis of a cohort who had planned to
have a home birth compared with a matched hospital birth group SETTING: Western
Australia (WA) PARTICIPANTS: all women (N = 976) who 'booked' to have a home
birth 1981-1987 and 2928 matched women who had a planned hospital birth
(singleton births only). MEASUREMENTS AND FINDINGS: women in the home birth
group had a longer labour, were less likely to have had labour induced or to
have had any sort of operative delivery. They were less likely overall to have
had complications of labour, but more likely to have had a postpartum
haemorrhage and more likely to have had a retained placenta. Babies in the home
birth group were heavier and more likely to be post-term. They were less likely
to have had an Apgar score below 8 at 5 minutes, to have taken more than 1
minute to establish respiration or to have received resuscitation. The crude
odds ratio for planned home births for perinatal mortality was 1.25 (95% CI
0.44-3.55). Postneonatal mortality was more common in the hospital group.
Planned home births were generally associated with less intervention than
hospital births and with less maternal and neonatal morbidity, with the
exception of third stage complications. Although not significant, the increase
in perinatal mortality has been observed in other Australian studies of home
births and requires continuing evaluation. KEY CONCLUSIONS: Planned home births
in WA appear to be associated with less overall maternal and neonatal morbidity
and less intervention than hospital births. IMPLICATIONS FOR PRACTICE: whether
these observed differences in intervention and morbidity have any relationship
to the small, non-significant increase in perinatal mortality could not be
determined in this study. Continuing evaluation of home birth practice and
outcome is essential.
Wolleswinkel-van
den Bosch JH, Vredevoogd CB, Borkent-Polet M, van Eyck J, Fetter WP,
Lagro-Janssen TL, Rosink IH, Treffers PE, Wierenga H, Amelink M, Richardus JH,
Verloove-Vanhorick P, Mackenbach JP.
Substandard
factors in perinatal care in The Netherlands: a regional audit of perinatal
deaths. Acta
Obstet Gynecol Scand 2002 Jan;81(1):17-24
BACKGROUND: To determine: 1) whether substandard factors were present in cases
of perinatal death, and to what extent another course of action might have
resulted in a better outcome, and 2) whether there were differences in the
frequency of substandard factors by level of care, particularly between midwives
and gynecologists/obstetricians and between home and hospital births. METHODS:
Population-based perinatal audit, with explicit evidence-based audit criteria.
SETTING: The northern part of the province of South-Holland in The Netherlands.
All levels of perinatal care (primary, secondary and tertiary care, and home and
hospital births) were included. CASES: Three hundred and forty-two cases of
perinatal mortality (24 weeks of pregnancy--28 days after birth). MAIN OUTCOME
MEASURES: Scores by a Dutch and a European audit panel. Score 0: no substandard
factors identified; score 1, 2 or 3: one or more substandard factors identified,
which were unlikely (1), possibly (2) or probably (3) related to the perinatal
death. RESULTS: In 25% of the perinatal deaths (95% Confidence Interval: 20-30%)
a substandard factor was identified that according to the Dutch panel was
possibly or probably related to the perinatal death. These were mainly
maternal/social factors (10% of all perinatal deaths; most frequent substandard
factor: smoking during pregnancy), and antenatal care factors (10% of all
perinatal deaths; most frequent substandard factor: detection of intra-uterine
growth retardation). We did not find statistically significant differences in
scores between midwives and gynecologists/obstetricians or between home and
hospital births. The European panel identified more substandard factors, but
these were again equally distributed by level of care. CONCLUSIONS: Perinatal
deaths might be partly preventable in The Netherlands. There is no evidence that
the frequency of substandard factors is related to specific aspects of the
perinatal care system in The Netherlands.
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