Mapping the trajectories for women and their babies from births planned at home, in a birth centre or in a hospital in New South Wales, Australia, between 2000 and 2012

Scarf, Vanessa; Viney, Rosalie; Yu, Serena; Foureur, Maralyn; Rossiter, Chris; Dahlen, Hannah; Thornton, Charlene; Cheah, Seong Leang; Homer, Caroline

doi:10.1186/s12884-019-2584-0

Cited by 9 publications

(7 citation statements)

References 35 publications

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“…The latter is consistent with findings by McNiven et al (2011), who found that 97% of midwives versus 29% of obstetricians agreed that out‐of‐hospital birth centers provide safe care 41 . These beliefs of medical staff are not consistent with evidence that has found out‐of‐hospital birth is safe for women with low‐risk pregnancies 42–44 . However, the disciplinary differences are not surprising given the conflicting recommendations in relation to home birth by medical 45 versus midwifery guidelines 46 .…”

Section: Discussionmentioning

confidence: 88%

The Attitudes and Beliefs of Australian Midwives and Obstetricians About Birth Options and Labor Interventions

Coates

Donnolley

Henry

2020

J Midwife Womens Health

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Introduction The global rise in the rate of induction of labor and cesarean birth shows considerable unexplained variation both within and between countries. Prior research suggests that the extent to which women are engaged in the decision‐making process about birth options, such as elective cesarean, induction of labor, or use of fetal monitoring, is heavily influenced by clinician beliefs and preferences. The aim of this study was to investigate the beliefs about labor interventions and birth options held by midwives and obstetric medical staff from 8 Sydney hospitals and assess how the health care providers’ beliefs were associated with discipline or years of experience. Methods This is a survey study of midwives and obstetric staff that was distributed between November 2018 and July 2019. Modified from the previously validated birth attitudes survey for the Australian context, survey domains include (1) maternal choice and woman's role in birth, (2) safety by mode or place of birth, (3) attitudes toward cesarean birth for preventing urinary incontinence, (4) approaches to decrease cesarean birth rates, and (5) fears of birth mode. Responses were compared between professions and within professions by years of experience using Mann‐Whitney U testing. Results A total of 217 midwives and 58 medical staff completed the survey (response rate, 30.5%). Midwifery staff responses generally favored a physiologic approach to birth, versus beliefs more in favor of intervention (particularly cesarean birth) among medical staff. There was interprofessional discrepancy on most items, particularly regarding safety of mode or place of birth and approaches to decrease cesarean birth rates. Within disciplines, there was more variation in medical staff attitudes than within the midwifery staff. No clinically important differences in beliefs by years of experience were noted. Discussion Clinicians need to be aware of their own beliefs and preferences about birth as a potential source of bias when counselling women, particularly when there are a range of treatment options and the evidence may not strongly favor one option over another. As both groups had similar perceptions about the importance of women's autonomy, shared decision‐making training could help bridge belief gaps and improve care around birth decisions.

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Section: Discussionmentioning

confidence: 88%

The Attitudes and Beliefs of Australian Midwives and Obstetricians About Birth Options and Labor Interventions

Coates

Donnolley

Henry

2020

J Midwife Womens Health

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“…Figure 2 illustrates these potential pathways and the number of women in the sample who followed each pathway are presented below each branch. A description of the conditional probabilities of each pathway has been presented in a previous publication [ 15 ]. Briefly, the normal vaginal birth rate in women planning a homebirth was 96.2% (including women who transferred to hospital), 91.1% for women planning birth in a birth centre (including transfers) and 79.5% in the hospital birth group.…”

Section: Resultsmentioning

confidence: 99%

“…This study used a decision analytic modelling framework to construct a decision tree which illustrated the pathways of women at low risk of complications who gave birth in NSW between 2000 and 2012 [ 15 ]. The pathways were developed by identifying planned place of birth, and then using descriptive statistics, we determined each pathway including planned and actual place of birth, transfer to hospital labour ward, mode of birth and possible admission to neonatal care unit.…”

Section: Methodsmentioning

confidence: 99%

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Modelling the cost of place of birth: a pathway analysis

Scarf

Viney

et al. 2021

BMC Health Serv Res

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Background In New South Wales (NSW), Australia there are three settings available for women at low risk of complications to give birth: home, birth centre and hospital. Between 2000 and 2012, 93.6% of babies were planned to be born in hospital, 6.0% in a birth centre and 0.4% at home. Availability of alternative birth settings is limited and the cost of providing birth at home or in a birth centre from the perspective of the health system is unknown. Objectives The objective of this study was to model the cost of the trajectories of women who planned to give birth at home, in a birth centre or in a hospital from the public sector perspective. Methods This was a population-based study using linked datasets from NSW, Australia. Women included met the following selection criteria: 37-41 completed weeks of pregnancy, spontaneous onset of labour, and singleton pregnancy at low risk of complications. We used a decision tree framework to depict the trajectories of these women and Australian Refined-Diagnosis Related Groups (AR-DRGs) were applied to each trajectory to estimate the cost of birth. A scenario analysis was undertaken to model the cost for 30 000 women in one year. Findings 496 387 women were included in the dataset. Twelve potential outcome pathways were identified and each pathway was costed using AR-DRGs. An overall cost was also calculated by place of birth: $AUD4802 for homebirth, $AUD4979 for a birth centre birth and $AUD5463 for a hospital birth. Conclusion The findings from this study provides some clarity into the financial saving of offering more options to women seeking an alternative to giving birth in hospital. Given the relatively lower rates of complex intervention and neonatal outcomes associated with women at low risk of complications, we can assume the cost of providing them with homebirth and birth centre options could be cost-effective.

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“…There are more birth centers than home birth programs in Australia, but only marginally. In 2016, there were at least 10 birth centers in NSW—five colocated on hospital premises or adjacent to hospital labor wards, and five midwifery‐led, free‐standing birth centers 43 . Pregnancy Birth and Beyond Pty Ltd lists 24 birth centers across Australia on their website, 44 catering to the 2.4% of Australian births 22 .…”

Section: Discussionmentioning

confidence: 99%

The opportunity costs of birth in Australia: Hospital resource savings for a post–COVID‐19 era

Callander

Bull

McInnes

et al. 2021

Birth

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Background COVID‐19 caused significant disruptions to health systems globally; however, restricting the family presence during birth saw an increase in women considering community birth options. This study aimed to quantify the hospital resource savings that could occur if all low‐risk women in Australia gave birth at home or in birth centers. Methods A whole‐of‐population linked administrative data set containing all women (n = 44 498) who gave birth in Queensland, Australia, between 01/07/2012 and 30/06/2015 was reweighted to represent all Australian women giving birth in 2017. A static microsimulation model of woman and infant health service resource use was created based on 2017 data. The model was comprised of a base model, representing "current" care, and a counterfactual model, representing hypothetical scenarios where all low‐risk Australian women gave birth at home or in birth centers. Results If all low‐risk women gave birth at home in 2017, cesarean rates would have reduced from 13.4% to 2.7%. Similarly, there would have been 860 fewer inpatient bed days and 10.1 fewer hours of women's intensive care unit time per 1000 births. If all women gave birth in birth centers, cesarean rates would have reduced to 6.7%. In addition, over 760 inpatient bed days would have been saved along with 5.6 hours of women's intensive care unit time per 1000 births. Conclusions Significant health resource savings could occur by shifting low‐risk births from hospitals to home birth and birth center services. Greater examination of Australian women's preferences for home birth and birth center birth models of care is needed.

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Mapping the trajectories for women and their babies from births planned at home, in a birth centre or in a hospital in New South Wales, Australia, between 2000 and 2012

Cited by 9 publications

References 35 publications

The Attitudes and Beliefs of Australian Midwives and Obstetricians About Birth Options and Labor Interventions

The Attitudes and Beliefs of Australian Midwives and Obstetricians About Birth Options and Labor Interventions

Modelling the cost of place of birth: a pathway analysis

The opportunity costs of birth in Australia: Hospital resource savings for a post–COVID‐19 era

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