Macfarlane A,
McCandlish R, Campbell R.
Choosing between home and hospital delivery. There is no evidence
that hospital is the safest place to give birth.
British Medical Journal. 2000 Mar 18;320(7237):798.
Olsen O, Jewell MD.
[The Nordic Cochrane Centre, Rigshospitalet, Blegdamsvej 9, dept.
7112, Copenhagen, Denmark, DK-2100 O. o.olsen@cochrane.dk]
Home versus hospital birth.
Cochrane Database Syst Rev 2000;(2)
BACKGROUND: A meta-analysis of observational studies have suggested
that planned home birth may be safe and with less interventions than
planned hospital birth. OBJECTIVES: The objective of this review was
to assess the effects of planned home birth compared to hospital birth
on the rates of interventions, complications and morbidity as
determined in randomised trials. SEARCH STRATEGY: We searched the
Cochrane Pregnancy and Childbirth Group trials register and the
Cochrane Controlled Trials Register. Date of last search: September
1999. SELECTION CRITERIA: Controlled trials comparing planned hospital
birth to planned home birth in selected women, assisted by an
experienced home birth practitioner, and backed up by a modern
hospital system in case transfer should be necessary. DATA COLLECTION
AND ANALYSIS: Trial quality was assessed and data were extracted by
one reviewer and checked by the other reviewer. Study authors were
contacted for additional information. MAIN RESULTS: One study
involving 11 women was included. The trial was of reasonable quality,
but was too small to be able to draw conclusions. REVIEWER'S
CONCLUSIONS: There is no strong evidence to favour either planned
hospital birth or planned home birth for low risk pregnant women.
Anderson RE. Anderson DA.
[Dept. of Economics, Centre College, Danville, KY 40422, USA. ]
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
[Obstetrics at Singleton Hospital, Swansea, UK]
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.
Aikins Murphy P, Feinland JB
Perineal outcomes in a home birth setting.
[Department of Obstetrics and Gynecology, Columbia University College
of Physicians and Surgeons, New York, USA.]
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.
Wiegers TA. van der Zee J. Keirse MJ.
[The Netherlands Institute of Primary Health Care, Utrecht, The
Netherlands. ]
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.
Olsen, O.
Meta-analysis of the Safety of Home Birth.
Birth. 24(1): 4-13, 1997.
Concludes: "Home birth is an acceptable alternative to
hospital confinement for selected pregnant women, and leads to reduced
medical interventions."
Hafner-Eaton C. Pearce LK.
Oregon State University
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.
Murphy PA. Fullerton J.
[Department of Obstetrics and Gynecology, Columbia University College
of Physicians and Surgeons, New York, New York 10032, USA. pam15@columbia.edu
]
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.
Bastian H. Keirse MJ.
Lancaster PA. [PO Box 569, Blackwood SA 5051, Australia.
hilda.bastian@flinders.edu.au ]
Perinatal death associated with planned home birth in
Australia: population based study.
BMJ. 317(7155):384-8, 1998 Aug 8.
OBJECTIVE: To assess the risk of perinatal death in planned
home births in Australia. DESIGN: Comparison of data on planned home
births during 1985-90, notified to Homebirth Australia, with national
data on perinatal deaths and outcomes of home births internationally.
RESULTS: 50 perinatal deaths occurred in 7002 planned home births in
Australia during 1985-90: 7.1 per 1000 (95% confidence interval 5.2 to
9.1) according to Australian definitions and 6.4 per 1000 (4.6 to 8.3)
according to World Health Organisation definitions. The perinatal
death rate in infants weighing more than 2500 g was higher than the
national average (5.7 versus 3.6 per 1000: relative risk 1.6; 1.1 to
2.4) as were intrapartum deaths not due to malformations or immaturity
(2.7 versus 0.9 per 1000: 3.0; 1. 9 to 4.8). More than half (52%) of
the deaths were associated with intrapartum asphyxia. CONCLUSIONS:
Australian home births carried a high death rate compared with both
all Australian births and home births elsewhere. The two largest
contributors to the excess mortality were underestimation of the risks
associated with post-term birth, twin pregnancy and breech
presentation, and a lack of response to fetal distress.
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.
Olsen O.
Afdeling for Social Medicin, Kobenhavns Universitet
[Home delivery and scientific reasoning]. [Norwegian] 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 dog-mas.
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.
Bortin S. Alzugaray M. Dowd J. Kalman J.
Santa Cruz Women's Health Center, California
A feminist perspective on the study of home birth. Application of a
midwifery care framework
Journal of Nurse-Midwifery. 39(3):142-9,
1994 May-Jun.
Studies of home birth have compared it with hospital birth, with a
focus on perinatal outcomes. Although such studies have established
the safety of midwife-attended home births, this narrow view does not
include all of the concepts represented in a proposed midwifery care
framework derived from the philosophy of the American College of
Nurse-Midwives. In this essay, the authors recommend the employment of
qualitative research with a feminist perspective as a method to
elucidate other concepts in the midwifery care framework, and suggest
that future home birth research should explore the recognition and
validation of the woman and her experiences, appropriate use of
technology, and the influences of the birth environment. [References:
51]
Davis-Floyd RE.
[Department of Anthropology, University of Texas at Austin 78712]
The technocratic body: American childbirth as cultural expression.
[Review] Social Science & Medicine. 38(8): 1125-40, 1994 Apr.
The dominant mythology of a culture is often displayed in the rituals
with which it surrounds birth. In contemporary Western society, that
mythology--the mythology of the technocracy--is enacted through
obstetrical procedures, the rituals of hospital birth. This article
explores the links between our culture's mythological technocratic
model of birth and the body images, individual belief and value
systems, and birth choices of forty middle-class women--32
professional women who accept the technocratic paradigm, and eight
homebirthers who reject it. The conceptual separation of mother and
child is fundamental to technocratic notions of parenthood, and
constitutes a logical corollary of the Cartesian mind-body separation
that has been fundamental to the development of both industrial
society and post-industrial technocracy. The professionals' body
images and lifestyles express these principles of separation, while
the holistic ideology of the homebirthers stresses mind-body and
parent-child integration. The conclusion considers the ideological
hegemony of the technocratic paradigm as potential future-shaper.
[References: 45]
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.
Sakala C.
[Health Policy Institute, Boston University, MA 02215]
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.
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.
Declercq ER.
[Merrimack College, North Andover, Massachusetts]
Where babies are born and who attends their births: findings from
the revised 1989 United States Standard Certificate of Live Birth
Obstetrics & Gynecology. 81(6):997-1004, 1993 Jun.
OBJECTIVE: To examine the results of changes in the birth certificate
with regard to characteristics of the mothers and the birth weights of
their infants. The United States Standard Certificate of Live Birth
was revised in 1989 to include specific designations for the place of
births out of hospital and the presence of a nurse-midwife or other
midwife at the birth. METHODS: All results are based on data from the
Natality, Marriage and Divorce Statistics Branch of the National
Center for Health Statistics, Centers for Disease Control. In all
cases reported here, the data represent at least 91% of all United
States births in 1989. RESULTS: Different patterns of birth attendance
emerged in different settings. In residential births, other midwives
and "others" attended 66% of all births, whereas in
freestanding birth centers, physicians and certified nurse-midwives
attended 75.1% of all births. The characteristics of the mothers
differed substantially according to who attended their births in these
settings. Substantial interstate variations in place and attendant
were also documented. CONCLUSION: The positive outcomes achieved in
certain settings indicate a need for further research into the factors
that influence birth outcomes.
MacVicar J. Dobbie G. Owen-Johnstone L. Jagger C. Hopkins M. Kennedy
J.
Department of Obstetrics & Gynaecology, Leicester Royal Infirmary,
UK
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.
Cunningham JD.
[School of Behavioural Sciences, Macquarie University, Sydney, NSW,
Australia]
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.
Eskes TK.
[Department of Obstetrics and Gynaecology, University Hospital Nijmegen,
The Netherlands]
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.
van Steensel-Moll HA. van Duijn CM. Valkenburg HA. van Zanen GE.
[Department of Epidemiology and Biostatistics, Erasmus University
Medical School, Rotterdam, The Netherlands]
Predominance of hospital deliveries among children with acute
lymphocytic leukemia: speculations about neonatal exposure to
fluorescent light
Cancer Causes & Control. 3(4):389-90, 1992 Jul.
Duran AM.
[Department of Health, Commonwealth of the Northern Marianas Islands,
Rota]
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.
Ford C. Iliffe S. Franklin O.
[Department of Primary Health Care, Whittington Hospital, London]
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.
Abel S. Kearns RA.
[Department of Anthropology, University of Auckland, New Zealand]
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.
Albers LL. Katz VL.
[University of Medicine and Dentistry of New Jersey]
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.
Kleiverda G. Steen AM. Andersen I. Treffers PE. Everaerd W.
[Department of Obstetrics and Gynaecology, Academic Medical Centre,
University of Amsterdam, The Netherlands]
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.
Mathews JJ. Zadak K.
[Loyola University Medical Center, Maywood, IL 60163]
The alternative birth movement in the United States: history and
current status
Women & Health. 17(1):39-56, 1991.
The alternative birth movement is a consumer reaction to paternalistic
and mechanistic medical obstetrical practices which developed in the
United States early in this century. Alternative birth settings
developed as single labor-delivery-recovery rooms in the hospital or
as free-standing birth centers. Both alternatives offer
family-centered, home-like, low technological maternity care. In order
to overcome physician resistance to non-traditional maternity care,
alternative birth center policies eliminate all women who are expected
to have a complicated pregnancy or delivery. Physician resistance to
alternative birthing is publicly based on the issue of maternal and
infant safety. Additional issues, however, are that physicians fear
economic competition and resist loss of control over obstetric
practice. This paper (1) traces the historical antecedents and social
factors leading to the alternative birth movement, (2) describes the
types of alternative birthing methods, and (3) describes ways in which
the obstetrical community has maintained and rationalized dominance
over the birthing process.
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.
Tyson H
Outcomes of 1001 midwife-attended home births in Toronto, 1983-1988
Birth. 18(1):14-9, 1991 Mar.
A retrospective descriptive study of 1001 midwife-attended home births
in Toronto, Ontario, was carried out between January 1983 and July
1988. Interviews with 26 midwives and reviews of client records
provided data on maternal age, socio-economic status, gestation,
ruptured membranes, length of labor, episiotomies and perineal
lacerations, transfer to hospital of mother or baby or both, infant
resuscitation, and breastfeeding. Of 1001 planned home births, 361
involved primiparous women, of whom 245 (68%) remained at home and 116
(32%) required transfer of mother or baby to hospital during labor or
the first four postpartum days. Of the 640 multiparous births, 591
(92%) women remained at home and 49 (8%) required transfer to
hospital. Among women transferred, 91 had spontaneous vaginal births,
34 had forceps deliveries, and 35 had cesarean sections. Variables
significantly associated with maternal transfer for both primiparas
and multiparas were length of latent and active phases of the first
stage of labor, length of the second stage of labor, and duration of
ruptured membranes. Five neonates were transferred and two died, one
each after birth at home and in hospital. There were no maternal
deaths. The proportion of mothers breastfeeding without supplement at
28 days postpartum was 98.6 percent.
jhughes@changesurfer.com
This page: http://www.changesurfer.com/Hlth/homebirth.html
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Birth
Chairs, Midwives and Medicine
by Amanda Carson Banks
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