Perinatal and maternal outcomes by planned place of birth for healthy women with low risk pregnancies : the Birthplace in England national prospective cohort study
Peter Brocklehurst,Peter Brocklehurst,Pollyanna Hardy,Jennifer Hollowell,Louise Linsell,Alison Macfarlane,Christine McCourt,Neil Marlow,Alison Miller,Mary Newburn,Stavros Petrou,David Puddicombe,Maggie Redshaw,Rachel Rowe,Jane Sandall,Louise Silverton,M F Stewart +16 more
TLDR
In this paper, the authors compare perinatal outcomes, maternal outcomes, and interventions in labour by planned place of birth at the start of care in labour for women with low risk pregnancies.Abstract:
Objective: To compare perinatal outcomes, maternal outcomes, and interventions in labour by planned place of birth at the start of care in labour for women with low risk pregnancies. Design: Prospective cohort study. Setting: England: all NHS trusts providing intrapartum care at home, all freestanding midwifery units, all alongside midwifery units (midwife led units on a hospital site with an obstetric unit), and a stratified random sample of obstetric units. Participants: 64 538 eligible women with a singleton, term (≥37 weeks gestation), and "booked" pregnancy who gave birth between April 2008 and April 2010. Planned caesarean sections and caesarean sections before the onset of labour and unplanned home births were excluded. Main outcome measure: A composite primary outcome of perinatal mortality and intrapartum related neonatal morbidities (stillbirth after start of care in labour, early neonatal death, neonatal encephalopathy, meconium aspiration syndrome, brachial plexus injury, fractured humerus, or fractured clavicle) was used to compare outcomes by planned place of birth at the start of care in labour (at home, freestanding midwifery units, alongside midwifery units, and obstetric units). Results: There were 250 primary outcome events and an overall weighted incidence of 4.3 per 1000 births (95% CI 3.3 to 5.5). Overall, there were no significant differences in the adjusted odds of the primary outcome for any of the non-obstetric unit settings compared with obstetric units. For nulliparous women, the odds of the primary outcome were higher for planned home births (adjusted odds ratio 1.75, 95% CI 1.07 to 2.86) but not for either midwifery unit setting. For multiparous women, there were no significant differences in the incidence of the primary outcome by planned place of birth. Interventions during labour were substantially lower in all non-obstetric unit settings. Transfers from non-obstetric unit settings were more frequent for nulliparous women (36% to 45%) than for multiparous women (9% to 13%). Conclusions: The results support a policy of offering healthy women with low risk pregnancies a choice of birth setting. Women planning birth in a midwifery unit and multiparous women planning birth at home experience fewer interventions than those planning birth in an obstetric unit with no impact on perinatal outcomes. For nulliparous women, planned home births also have fewer interventions but have poorer perinatal outcomes.read more
Citations
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Midwife‐led continuity models versus other models of care for childbearing women
TL;DR: Women who had midwife-led continuity models of care were less likely to experience regional analgesia and spontaneous vaginal birth and more likely to be attended at birth by a known midwife, according to the quality of the trial evidence.
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Third- and fourth-degree perineal tears among primiparous women in England between 2000 and 2012: time trends and risk factors.
Ipek Gurol-Urganci,Ipek Gurol-Urganci,David A Cromwell,Leroy C. Edozien,Tahir Mahmood,EJ Adams,David H Richmond,A Templeton,J van der Meulen +8 more
TL;DR: To describe the trends of severe perineal tears in England and to investigate to what extent the changes in related risk factors could explain the observed trends.
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The projected effect of scaling up midwifery.
Caroline S.E. Homer,Ingrid K. Friberg,Marcos Augusto Bastos Dias,Petra ten Hoope-Bender,Jane Sandall,Anna Maria Speciale,Linda Bartlett +6 more
TL;DR: Midwifery care has the greatest effect when provided within a functional health system with effective referral and transfer mechanisms to specialist care, meaning that midwifers can avert 83% of all maternal deaths, stillbirths, and neonatal deaths.
Journal ArticleDOI
Incidence of and risk factors for perineal trauma: a prospective observational study
TL;DR: A large prospective study on women with a planned singleton vaginal delivery between May and September 2006 found no evidence for an association between many factors related to midwifery practice such as use of a birthing pool, digital perineal stretching in the second stage, hands off delivery technique, or maternal birth position with incidence of OASIS or spontaneous perineAL trauma.
Journal ArticleDOI
Alternative versus conventional institutional settings for birth
TL;DR: Assessment of the effects of care in an alternative institutional birth environment compared to care in a conventional setting found hospital birth centres are associated with lower rates of medical interventions during labour and birth and higher levels of satisfaction, without increasing risk to mothers or babies.
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Book
Analyzing Health Equity Using Household Survey Data: A Guide to Techniques and their Implementation
TL;DR: This book shows how to implement a variety of analytic tools that allow health equity - along different dimensions and in different spheres - to be quantified to lead to more comprehensive monitoring of trends in health equity, a better understanding of the causes of these inequities, and more extensive evaluation of the impacts of development programs on health equity.
Journal ArticleDOI
Outcomes of planned home birth with registered midwife versus planned hospital birth with midwife or physician
TL;DR: In this paper, the authors found that women in the planned home-birth group were significantly less likely than those who planned a midwife-attended hospital birth to have obstetric interventions (e.g., electronic fetal monitoring, relative risk [RR] 0.32, 95% CI 0.29-0.59; postpartum hemorrhage, RR 0.59).
Journal ArticleDOI
Perinatal mortality and morbidity in a nationwide cohort of 529 688 low-risk planned home and hospital births
A. de Jonge,B.Y. van der Goes,Anita C.J. Ravelli,M.P. Amelink-Verburg,Ben W.J. Mol,Jan G. Nijhuis,J. Bennebroek Gravenhorst,Simone Buitendijk +7 more
TL;DR: Perinatal mortality and severe perinatal morbidity between planned home and planned hospital births, among low‐risk women who started their labour in primary care, are compared.