Homebirths in a modern setting – a cautionary tale

Högberg, Ulf

doi:10.1080/00016340802348534

Cited by 10 publications

(5 citation statements)

References 17 publications

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“…1,2 Currently, the only Western nation doing a substantial number of home births (B30% of all births) is the Netherlands. 3 The Royal College of Obstetricians and Gynecologists in conjunction with the Royal College of Midwives in the United Kingdom, 'support the provision of home birth services for women at low risk of complications.' 4 The Society of Obstetricians and Gynaecologists of Canada, 'recognizes and stresses the importance of choice for women and their families in the birthing process.'…”

Section: Introductionmentioning

confidence: 99%

Infant outcomes of certified nurse midwife attended home births: United States 2000 to 2004

Malloy

2010

J Perinatol

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Objective: Home births attended by certified nurse midwives (CNMs) make up an extremely small proportion of births in the United States (<1.0%) and are not supported by the American College of Obstetrics and Gynecology (ACOG). The primary objective of this analysis was to examine the safety of certified nurse midwife attended home deliveries compared with certified nurse midwife in-hospital deliveries in the United States as measured by the risk of adverse infant outcomes among women with term, singleton, vaginal deliveries.Study Design: United States linked birth and infant death files for the years 2000 to 2004 were used for the analysis. Adverse neonatal outcomes including death were determined by place of birth and attendant type for in-hospital certified nurse midwife, in-hospital 'other' midwife, home certified nurse midwife, home 'other' midwife, and free-standing birth center certified nurse midwife deliveries.Result: For the 5-year period there were 1 237 129 in-hospital certified nurse midwife attended births; 17 389 in-hospital 'other' midwife attended births; 13 529 home certified nurse midwife attended births; 42 375 home 'other' midwife attended births; and 25 319 birthing center certified nurse midwife attended births. The neonatal mortality rate per 1000 live births for each of these categories was, respectively, 0.5 (deaths ¼ 614), 0.4 (deaths ¼ 7), 1.0 (deaths ¼ 14), 1.8 (deaths ¼ 75), and 0.6 (deaths ¼ 16). The adjusted odds ratio (95% confidence interval) for neonatal mortality for home certified nurse midwife attended deliveries vs in-hospital certified nurse midwife attended deliveries was 2.02 (1.18, 3.45).Conclusion: Deliveries at home attended by CNMs and 'other midwives' were associated with higher risks for mortality than deliveries in-hospital by CNMs.

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Section: Introductionmentioning

confidence: 99%

Infant outcomes of certified nurse midwife attended home births: United States 2000 to 2004

Malloy

2010

J Perinatol

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“…The favorable obstetric and neonatal outcomes presented in this study may have been infl uenced by the fact that women who choose to give birth at home cul vate posi ve expecta ons regarding childbirth and end up having fewer complica ons than those who choose the hospital (20) . The op on for most of the women to be transferred to a private healthcare ins tu on and to be a ended by the prenatal physician can be a ributed to their purchasing power, as the majority had paid employment and higher educa on levels, as well as the rela onship of trust between the parturient and the professional.…”

Section: Discussionmentioning

confidence: 94%

Partos domiciliares planejados assistidos por enfermeiras obstétricas: transferências maternas e neonatais

Koettker

Brüggemann

Düfloth

2013

Rev. esc. enferm. USP

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Planned homebirths assisted by midwives: maternal and neonatal transfersKoettker JG, Brüggemann OM, Dufl oth RM RESUMO O presente trabalho trata-se de estudo exploratório-descri vo que teve como obje vo descrever a taxa e as causas de transferência intraparto para o hospital de mulheres assis das no domicílio por enfermeiras obstétricas e os desfechos desses nascimentos. A amostra foi composta por onze mulheres e seus recém-nascidos, de janeiro de 2005 a dezembro de 2009. Os dados foram coletados em prontuários e cadernetas de saúde e analisados por esta s ca descri va. A taxa de transferência foi de 11%, a maioria de nulíparas (63,6%), e todas foram transferidas durante o primeiro período clínico do parto. Os mo vos mais frequentes de transferência foram parada de dilatação cervical e progressão da apresentação fetal, e desproporção cefalopélvica. Os escores de Apgar no 1º e 5º minutos foram ≥7 em 81,8% dos casos e não houve internação em unidade de terapia intensiva neonatal. Neste estudo constatou--se que o parto domiciliar planejado assis do por enfermeiras obstétricas, com protocolo assistencial, apresentou bons resultados maternos e neonatais, mesmo quando a transferência para o hospital foi necessária. DESCRITORES Parto domiciliar Enfermagem obstétrica Transferência de pacientes Hospitalização ORIGINAL ARTICLE ABSTRACTThe objec ve of this explora ve and descrip ve study was to describe the rates and reasons for intrapartum transfers from home to hospital among women assisted by nurse midwives, and the outcomes of those deliveries. The sample consisted of eleven women giving birth and their newborns, from January 2005 to December 2009. Data was collected from the maternal and neonatal records and was analyzed using descrip ve sta s cs. The transfer rate was 11%, most of the women were nulliparous (63.6%), and all of them were transferred during the first stage of labor. The most common reasons for transfer were arrested cervical dila on, arrested progress of the fetal head and cephalopelvic dispropor on. Apgar scores were ≥7 for 81.8% of the newborns; and there were no admissions to the neonatal intensive care unit. The results show that planned home births assisted by nurse midwives following a clinical protocol, had good outcomes even when a transfer to the hospital was needed. DESCRIPTORSHome childbirth Obstetrical nursing Pa ent transfer Hospitaliza on RESUMEN Estudio exploratorio descriptivo que obje vó describir la tasa y causas de traslados hospitalarios intraparto a mujeres atendidas en domicilio por enfermeras obstétricas y los desenlaces de tales nacimientos. Muestra compuesta por once mujeres y sus recién nacidos, de enero 2005 a diciembre 2009; datos recolectados a par r de historia clínicas y carpetas de salud, analizadas por estadís ca descrip va. La tasa de traslado fue 11,0%, mayoritariamente de nulíparas (63,3%), todas ellas trasladadas durante el primer período clínico del parto. Los mo vos más frecuentes obedecieron a interrupción de dilatación cervical, progresión de presentación fetal ...

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“…There is relevance to those in other countries involved in similar debates, such as Ireland, North America and some European countries (Bortin et al. ; Hafner‐Eaton and Pearce ; Högberg ; Barros et al. ; Wax, Lucas and Lamont ; Dahlen ; Oboyle ).…”

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confidence: 91%

‘Risk or Right’: a discourse analysis of midwifery and obstetric colleges’ homebirth position statements

Licqurish

Evans

2015

Nursing Inquiry

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Within the context of global debates about safety and ethics of supporting women to give birth at home, it is important to analyse documents governing midwifery and obstetric practice and influence decision-making around place of birth. In Australia, the United States and the United Kingdom, relatively small numbers of women choose to give birth at home despite their midwifery colleges' support. In the United States and Australia, the obstetric colleges do not support homebirth and these countries have lower numbers of women who birth at home, compared with the United Kingdom. There are numerous regulatory and industry challenges for midwives attending homebirths. This paper reports on a Foucauldian analysis of Australian obstetric and midwifery colleges' position statements about homebirth, who have conflicting views, with the view to understanding their arguments and underlying assumptions. The documents highlighted tensions between competing discourses of risk and autonomy and differences in academic argument. Opportunities for strengthening their statements are highlighted. The methodology is applicable for future analysis of similar documents governing practice in other countries.

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Homebirths in a modern setting – a cautionary tale

Cited by 10 publications

References 17 publications

Infant outcomes of certified nurse midwife attended home births: United States 2000 to 2004

Infant outcomes of certified nurse midwife attended home births: United States 2000 to 2004

Partos domiciliares planejados assistidos por enfermeiras obstétricas: transferências maternas e neonatais

‘Risk or Right’: a discourse analysis of midwifery and obstetric colleges’ homebirth position statements

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