Publicly funded homebirth in Australia: a review of maternal and neonatal outcomes over 6 years

Catling, Christine; Coddington, Rebecca; Foureur, Maralyn; Homer, Caroline

doi:10.5694/mja12.11665

Cited by 49 publications

(24 citation statements)

References 30 publications

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“… 37 Rates of perineal lacerations were similarly low for planned home births in southern Australia (34.2% first to second degree, 1.1% third or fourth degree). 24 Rates of other maternal complications such as retained placenta or endometritis were also low in this home birth population. 24 In comparison with planned hospital birth, postpartum hemorrhage rates (>500 mL blood loss) are either the same 32 or lower in women who plan home birth, 26 , 27 and they are less likely to receive blood transfusion.…”

Section: Resultsmentioning

confidence: 75%

“… 25 A descriptive study of publicly funded home birth in Australia reported a stillbirth and early neonatal death rate of 3.3/1,000, which was reduced to 1.7/1,000 when deaths related to fetal anomalies were excluded. 24 …”

Section: Resultsmentioning

confidence: 99%

“…While some studies suggest a small but significant increase in neonatal death and adverse outcomes, 23 , 35 , 36 , 38 , 39 , 45 the majority of studies across a variety of countries have shown no increase in neonatal morbidity and mortality for planned home birth. 4 , 6 , 10 , 24 – 30 , 37 , 40 Additionally, maternal outcomes are consistently better for planned home birth, including less intervention and fewer complications. 5 , 6 , 10 , 20 , 23 – 28 , 31 , 32 – 35 , 37 Satisfaction with the birth experience is also high in the home birth setting.…”

Section: Discussionmentioning

confidence: 99%

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Planned home birth: benefits, risks, and opportunities

Zielinski

Ackerson

Low

2015

IJWH

103

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While the number of women in developed countries who plan a home birth is low, the number has increased over the past decade in the US, and there is evidence that more women would choose this option if it were readily available. Rates of planned home birth range from 0.1% in Sweden to 20% in the Netherlands, where home birth has always been an integrated part of the maternity system. Benefits of planned home birth include lower rates of maternal morbidity, such as postpartum hemorrhage, and perineal lacerations, and lower rates of interventions such as episiotomy, instrumental vaginal birth, and cesarean birth. Women who have a planned home birth have high rates of satisfaction related to home being a more comfortable environment and feeling more in control of the experience. While maternal outcomes related to planned birth at home have been consistently positive within the literature, reported neonatal outcomes during planned home birth are more variable. While the majority of investigations of planned home birth compared with hospital birth have found no difference in intrapartum fetal deaths, neonatal deaths, low Apgar scores, or admission to the neonatal intensive care unit, there have been reports in the US, as well as a meta-analysis, that indicated more adverse neonatal outcomes associated with home birth. There are multiple challenges associated with research designs focused on planned home birth, in part because conducting randomized controlled trials is not feasible. This report will review current research studies published between 2004 and 2014 related to maternal and neonatal outcomes of planned home birth, and discuss strengths, limitations, and opportunities regarding planned home birth.

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Section: Resultsmentioning

confidence: 75%

Section: Resultsmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Planned home birth: benefits, risks, and opportunities

Zielinski

Ackerson

Low

2015

IJWH

103

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“…We created a study flow diagram to map out the number of records identified, included and excluded (Liberati 2009). …”

Section: Methodsmentioning

confidence: 99%

Selective versus routine use of episiotomy for vaginal birth

Jiang

Qian

Carroli

et al. 2017

Cochrane Database of Systematic Reviews

315

340

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Background Some clinicians believe that routine episiotomy, a surgical cut of the vagina and perineum, will prevent serious tears during childbirth. On the other hand, an episiotomy guarantees perineal trauma and sutures. Objectives To assess the effects on mother and baby of a policy of selective episiotomy ('only if needed') compared with a policy of routine episiotomy ('part of routine management') for vaginal births. Search methods We searched Cochrane Pregnancy and Childbirth's Trials Register (14 September 2016) and reference lists of retrieved studies. Selection criteria Randomised controlled trials (RCTs) comparing selective versus routine use of episiotomy, irrespective of parity, setting or surgical type of episiotomy. We included trials where either unassisted or assisted vaginal births were intended. Quasi‐RCTs, trials using a cross‐over design or those published in abstract form only were not eligible for inclusion in this review. Data collection and analysis Two authors independently screened studies, extracted data, and assessed risk of bias. A third author mediated where there was no clear consensus. We observed good practice for data analysis and interpretation where trialists were review authors. We used fixed‐effect models unless heterogeneity precluded this, expressed results as risk ratios (RR) and 95% confidence intervals (CI), and assessed the certainty of the evidence using GRADE. Main results This updated review includes 12 studies (6177 women), 11 in women in labour for whom a vaginal birth was intended, and one in women where an assisted birth was anticipated. Two were trials each with more than 1000 women (Argentina and the UK), and the rest were smaller (from Canada, Germany, Spain, Ireland, Malaysia, Pakistan, Columbia and Saudi Arabia). Eight trials included primiparous women only, and four trials were in both primiparous and multiparous women. For risk of bias, allocation was adequately concealed and reported in nine trials; sequence generation random and adequately reported in three trials; blinding of outcomes adequate and reported in one trial, blinding of participants and personnel reported in one trial. For women where an unassisted vaginal birth was anticipated, a policy of selective episiotomy may result in 30% fewer women experiencing severe perineal/vaginal trauma (RR 0.70, 95% CI 0.52 to 0.94; 5375 women; eight RCTs; low‐certainty evidence). We do not know if there is a difference for blood loss at delivery (an average of 27 mL less with selective episiotomy, 95% CI from 75 mL less to 20 mL more; two trials, 336 women, very low‐certainty evidence). Both selective and routine episiotomy have little or no effect on infants with Apgar score less than seven at five minutes (four trials, no events; 3908 women, moderate‐certain...

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“…Adrenaline interferes with the uptake of oxytocin at the myometrial receptor site (Gimpl and Farenholtz, 2001;Odent, 2001;Tortora and Grabowski, 2003;Stables and Rankin, 2005;Coad and Dunstall, 2011;Saxton et al, 2014) causing uterine atony. Midwifery models of care where midwives practice pronurturance demonstrate low rates of PPH (Dixon et al, 2009;Fahy et al, 2010;Catling-Paull et al, 2013). Maybe the hypermedicalization of birth (Simpson and Thorman, 2005;Zwelling, 2008;Rossen et al, 2010;Belghiti et al, 2011) is interfering with innate pronurturance behaviours at birth.…”

Section: Introductionmentioning

confidence: 94%