Safety of Midwifery care, homebirths, and birth center care studies.

Evidence Confirms Birth Centers Provide Top-Notch Care

by Rebecca Dekker, PhD, RN, APRN for the American Association of Birth Centers, January 31, 2013.

We have reached a dramatic cross-road when it comes to maternity care in the U.S. Will we, as a country, continue on our current path of rising C-section rates, excessive costs, and poorer maternal outcomes than 33 other first-world countries?[1] Or will we begin to expand other options for receiving optimal care during our births?

A landmark study published in the Journal of Midwifery and Women’s Health,[2] shows that birth centers provide first-rate care to healthy pregnant women in the U.S. The purpose of this article is to fill you in on what the The National Birth Center Study II found and what it means for moms and families.

Read more at the link below…

http://www.birthcenters.org/?page=NBCSII

Outcomes of Care for 16,924 Planned Home Births in the United States: The Midwives Alliance of North America Statistics Project, 2004 to 2009

Authors

  • Marit Bovbjerg PhD, MS,

  • Courtney Everson MA,

  • Wendy Gordon MPH, CPM, LM,

  • Darcy Hannibal PhD,

  • Saraswathi Vedam CNM, MSN, RM

Abstract

Introduction

Between 2004 and 2010, the number of home births in the United States rose by 41%, increasing the need for accurate assessment of the safety of planned home birth. This study examines outcomes of planned home births in the United States between 2004 and 2009.

Methods

We calculated descriptive statistics for maternal demographics, antenatal risk profiles, procedures, and outcomes of planned home births in the Midwives Alliance of North American Statistics Project (MANA Stats) 2.0 data registry. Data were analyzed according to intended and actual place of birth.

Results

Among 16,924 women who planned home births at the onset of labor, 89.1% gave birth at home. The majority of intrapartum transfers were for failure to progress, and only 4.5% of the total sample required oxytocin augmentation and/or epidural analgesia. The rates of spontaneous vaginal birth, assisted vaginal birth, and cesarean were 93.6%, 1.2%, and 5.2%, respectively. Of the 1054 women who attempted a vaginal birth after cesarean, 87% were successful. Low Apgar scores (< 7) occurred in 1.5% of newborns. Postpartum maternal (1.5%) and neonatal (0.9%) transfers were infrequent. The majority (86%) of newborns were exclusively breastfeeding at 6 weeks of age. Excluding lethal anomalies, the intrapartum, early neonatal, and late neonatal mortality rates were 1.30, 0.41, and 0.35 per 1000, respectively.

Discussion

For this large cohort of women who planned midwife-led home births in the United States, outcomes are congruent with the best available data from population-based, observational studies that evaluated outcomes by intended place of birth and perinatal risk factors. Low-risk women in this cohort experienced high rates of physiologic birth and low rates of intervention without an increase in adverse outcomes.

For the full article follow this link below.

http://onlinelibrary.wiley.com/doi/10.1111/jmwh.12172/abstract

 

Netherlands Homebirth Study

Perinatal mortality and morbidity in a nationwide cohort of 529 688 low-risk planned home and hospital births


ABSTRACT

Objective: To compare perinatal mortality and severe perinatal morbidity between planned home and planned hospital births, among low-risk women who started their labour in primary care.

Design: A nationwide cohort study.

Setting: The entire Netherlands.

Population: A total of 529 688 low-risk women who were in primary midwife-led care at the onset of labour. Of these, 321 307 (60.7%) intended to give birth at home, 163 261 (30.8%) planned to give birth in hospital and for 45 120 (8.5%), the intended place of birth was unknown.

Methods: Analysis of national perinatal and neonatal registration data, over a period of 7 years. Logistic regression analysis was used to control for differences in baseline characteristics.

Main outcome measures Intrapartum death, intrapartum and neonatal death within 24 hours after birth, intrapartum and neonatal death within 7 days and neonatal admission to an intensive care unit.

Results: No significant differences were found between planned home and planned hospital birth (adjusted relative risks and 95% confidence intervals: intrapartum death 0.97 (0.69 to 1.37), intrapartum death and neonatal death during the first 24 hours 1.02 (0.77 to 1.36), intrapartum death and neonatal death up to 7 days 1.00 (0.78 to 1.27), admission to neonatal intensive care unit 1.00 (0.86 to 1.16).

Conclusions: This study shows that planning a home birth does not increase the risks of perinatal mortality and severe perinatal morbidity among low-risk women, provided the maternity care system facilitates this choice through the availability of well-trained midwives and through a good transportation and referral system.


A de Jonge a , BY van der Goes b , ACJ Ravelli c , MP Amelink-Verburg a,d , BW Mol b , JG Nijhuis e , J Bennebroek Gravenhorst a , SE Buitendijk a, a TNO Quality of Life, Leiden, the Netherlands b Department of Obstetrics and Gynaecology, Amsterdam Medical Centre, Amsterdam, the Netherlands c Department of Medical Informatics, Amsterdam Medical Centre, Amsterdam, the Netherlands d Health Care Inspectorate, Rijswijk, the Netherlands e Department of Obstetrics and Gynaecology, Maastricht University Medical Centre, Maastricht, the Netherlands
Correspondence to Dr A de Jonge, TNO Quality of Life, P.O. Box 2215, 2301 CE Leiden, the Netherlands. Email ankdejonge@hotmail.com
Copyright Journal compilation © 2009 RCOG
KEYWORDS
Midwifery • perinatal mortality • pregnancy outcome


Accepted 26 February 2009. Published Online 15 April 2009.