Sunday, September 07, 2014

Latest Homebirth Research



Outcome of Planned Home and Hospital Births among Low-Risk Women in Iceland in 2005–2009: A Retrospective Cohort Study

DOI: 10.1111/birt.12150


Study published 23 January 2015.  The rate of oxytocin augmentation, epidural analgesia, and postpartum hemorrhage was significantly lower when labor started as a planned home birth. Differences in the rates of other primary outcome variables were not significant. The home birth group had lower rates of operative birth and obstetric anal sphincter injury. The rate of 5-minute Apgar score < 7 was the same in the home and hospital birth groups, but the home birth group had a higher rate of neonatal intensive care unit admission. Intervention and adverse outcome rates in both study groups, including transfer rates, were higher among primiparas than multiparas. Oxytocin augmentation, epidural analgesia, and postpartum hemorrhage rates were significantly interrelated.  Home in Iceland is higher than in all the Nordic countries. 


Perinatal and maternal outcomes in planned home and obstetric unit births in women at 'higher risk' of complications: secondary analysis of the Birthplace national prospective cohort study


http://onlinelibrary.wiley.com/doi/10.1111/1471-0528.13283/pdf

The babies of ‘higher risk’ women who plan birth in an obstetric unit appear more likely to be admitted to neonatal care than those whose mothers plan birth at home.




Place of birth and outcomes for a cohort of low risk women in New Zealand: A comparison with Birthplace England.

http://www.midwife.org.nz/resources-events/nzcom-journal/issue-50/place-of-birth-and-outcomes-for-low-risk-women

A greater proportion of indigenous New Zealand women planned to birth at home or in a primary unit. Fewer women were transferred in labour in the NZ study. This research further refines our understanding of who plans to birth where, and reinforces the evidence that, where a low risk woman plans to birth in NZ, does not significantly increase adverse outcomes for her baby.



Center for Disease Control study finds Home Births Safe

In 2009, there were 29,650 home births in the United States (representing 0.72% of births), the highest level since data on this item began to be collected in 1989.  Home births have a lower risk profile than hospital birth, and the percentage of home births that were low birthweight was 4%, compared with 8% for hospital births.

http://www.cdc.gov/nchs/data/databriefs/db84.pdf



The St. George Homebirth Program: an evaluation of the first 100 booked women.



Of the first 100 booked women, 63 achieved a homebirth, 30 were transferred to hospital or independent midwifery care in the antenatal period and seven were transferred intrapartum. Two women were transferred to hospital in the early postnatal period, one for a postpartum haemorrhage and one for hypotension. One baby suffered mild respiratory distress, was treated in the emergency department and was discharged home within four hours.

CONCLUSION:

The St. George Hospital homebirth program has provided reassuring outcomes for the first 100 women it has cared for over the past four years. Wider availability of this service could be achieved provided there is the appropriate close collaboration between providers and effective processes for consultation, referral and transfer. The outcomes of women and babies in publicly funded homebirth programs deserve further study, and the development of a national prospective database of all planned homebirth would contribute to this knowledge.





Paper

Outcomes of planned home births with certified professional midwives: large prospective study in North America

BMJ  2005;330:1416 (18 June), doi:10.1136/bmj.330.7505.1416

Kenneth C Johnsonsenior epidemiologist1Betty-Anne Davissproject manager2
1 Surveillance and Risk Assessment Division, Centre for Chronic Disease Prevention and Control, Public Health Agency of Canada, PL 6702A, Ottawa, ON, Canada K1A OK9, 2 Safe Motherhood/Newborn Initiative, International Federation of Gynecology and Obstetrics, Ottawa, Canada
Correspondence to: K C Johnson ken_lcdc_johnson@phac-aspc.gc.ca

Objective To evaluate the safety of home births in North America involving direct entry midwives, in jurisdictions where the practice is not well integrated into the healthcare system.

Design Prospective cohort study.

Setting All home births involving certified professional midwives across the United States (98% of cohort) and Canada, 2000.

Participants All 5418 women expecting to deliver in 2000 supported by midwives with a common certification and who planned to deliver at home when labour began.

Main outcome measures Intrapartum and neonatal mortality, perinatal transfer to hospital care, medical intervention during labour, breast feeding, and maternal satisfaction.

Results 655 (12.1%) women who intended to deliver at home when labour began were transferred to hospital. Medical intervention rates included epidural (4.7%), episiotomy (2.1%), forceps (1.0%), vacuum extraction (0.6%), and caesarean section (3.7%); these rates were substantially lower than for low risk US women having hospital births. The intrapartum and neonatal mortality among women considered at low risk at start of labour, excluding deaths concerning life threatening congenital anomalies, was 1.7 deaths per 1000 planned home births, similar to risks in other studies of low risk home and hospital births in North America. No mothers died. No discrepancies were found for perinatal outcomes independently validated.

Conclusions Planned home birth for low risk women in North America using certified professional midwives was associated with lower rates of medical intervention but similar intrapartum and neonatal mortality to that of low risk hospital births in the United States.


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