Remote rural women's choice of birthplace and transfer experiences in rural Otago and Southland New Zealand

Patterson, Jean; Foureur, Maralyn; Skinner, Joan

doi:10.1016/j.midw.2017.05.014

Cited by 8 publications

(12 citation statements)

References 55 publications

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“…… And my midwife said that if you have it in your head (that you don't feel safe) then it is going to get in the way of the labour taking place and that you need to be in the place where you are going to birth and then it will just happen. [ [63] p52].…”

Section: Analytical Themesmentioning

confidence: 99%

Women’s experiences of decision-making and informed choice about pregnancy and birth care: a systematic review and meta-synthesis of qualitative research

Yuill

McCourt

Cheyne

et al. 2020

BMC Pregnancy Childbirth

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Background: The purpose of this systematic review (PROSPERO Ref: CRD42017053264) was to describe and interpret the qualitative research on parent's decision-making and informed choice about their pregnancy and birth care. Given the growing evidence on the benefits of different models of maternity care and the prominence of informed choice in health policy, the review aimed to shed light on the research to date and what the findings indicate. Methods: a systematic search and screening of qualitative research concerning parents' decision-making and informed choice experiences about pregnancy and birth care was conducted using PRISMA guidelines. A metasynthesis approach was taken for the extraction and analysis of data and generation of the findings. Studies from 1990s onwards were included to reflect an era of policies promoting choice in maternity care in high-income countries. Results: Thirty-seven original studies were included in the review. A multi-dimensional conceptual framework was developed, consisting of three analytical themes ('Uncertainty', 'Bodily autonomy and integrity' and 'Performing good motherhood') and three inter-linking actions ('Information gathering,' 'Aligning with a birth philosophy,' and 'Balancing aspects of a choice'). Conclusions: Despite the increasing research on decision-making, informed choice is not often a primary research aim, and its development in literature published since the 1990s was difficult to ascertain. The meta-synthesis suggests that decision-making is a dynamic and temporal process, in that it is made within a defined period and invokes both the past, whether this is personal, familial, social or historical, and the future. Our findings also highlighted the importance of embodiment in maternal health experiences, particularly when it comes to decisionmaking about care. Policymakers and practitioners alike should examine critically current choice frameworks to ascertain whether they truly allow for flexibility in decision-making. Health systems should embrace more fluid, personalised models of care to augment service users' decision-making agency.

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Section: Analytical Themesmentioning

confidence: 99%

Women’s experiences of decision-making and informed choice about pregnancy and birth care: a systematic review and meta-synthesis of qualitative research

Yuill

McCourt

Cheyne

et al. 2020

BMC Pregnancy Childbirth

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“…Distance from a maternity unit not only impacts on delivery plans but also increases distress for those having to travel large distances and for those labouring en route . Aboriginal and Torres Strait Islander women, 55% of whom live in outer regional and remote areas of Australia, report high rates of pregnancy stress and low levels of birthing choice .…”

Section: Introductionmentioning

confidence: 99%

“…2 These findings are consistent with international research, and a large population study in British Columbia between 2000 and 2004 found that the odds of having an unplanned out of hospital birth is 6.41 (95% CI 3.69, 11.28) for women 1-2 hours away from services with statistically significant increases in perinatal mortality for newborns whose mothers reside more than 4 hours from services, as well as induction rates for logistical reasons highest for women located 2-4 hours from services. 6 Distance from a maternity unit not only impacts on delivery plans but also increases distress for those having to travel large distances 7 and for those labouring en route. 4 Aboriginal and Torres Strait Islander women, 55% of whom live in outer regional and remote areas of Australia, 8 report high rates of pregnancy stress and low levels of birthing choice.…”

Section: Introductionmentioning

confidence: 99%

Access and outcomes of general practitioner obstetrician (rural generalist)‐supported birthing units in Queensland

Tennett

Kearney

2020

Australian J Rural Health

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Objective To describe characteristics and outcomes of women birthing within GP‐obstetrician (rural generalist) supported rural (level 3) obstetric units in Queensland. Design Retrospective descriptive study. Setting 21 GP‐obstetrician supported birthing units in Queensland. Participants Women (n = 3111) birthing from January 2017 to December 2017. Main outcome measures Patient, pregnancy and labour characteristics and key maternal and neonatal outcomes routinely recorded in the Queensland Perinatal Data Collection and Queensland Hospital Admitted Patient Data Collection were compared to Queensland public hospital aggregate data. Results Women birthing in rural maternity units were significantly more likely to be Aboriginal or Torrs Strait Islander (16% v 9%), < 20 years old (7% v 4%), term deliveries (96% v 91%), achieve spontaneous onset of labour (67% v 51%), and birth (71% v 60%) (p<0.001) compared with all Queensland public hospitals. They were significantly less likely to be nulliparous (36% v 40%), use pharmacological analgesia (65% v 69%), or have continuous electronic fetal monitoring in labour (54% v 66%) (p<0.001). Neonatal outcomes were comparable; with no significant difference in stillbirth rate between rural units and all Queensland public hospitals (4.8 v 7.3 per 1000 births). Precipitate delivery was the most common labour complication (36% v 33%) (p<0.001). Conclusion GP‐obstetrician (rural generalist) supported rural birthing units in Queensland provide important access for low and medium risk women to deliver locally, with strong indicators of quality and safety.

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“…Our research makes a unique contribution to the literature on the distance between planned place of birth and a facility with cesarean capability. Qualitative research from New Zealand and Canada suggests that women living in rural and remote areas in high‐income countries consider issues of safety when making decisions regarding where to give birth, highlighting the need for good information to inform these decisions. Although several studies have examined rates, indications, and duration of transfer to a hospital from out‐of‐hospital settings, we were unable to identify research from high‐income settings that examined the association between duration of transfer to a hospital for individuals planning home births and their clinical outcomes.…”

Section: Discussionmentioning

confidence: 99%

Distance from Home Birth to Emergency Obstetric Services and Neonatal Outcomes: A Cohort Study

Darling¹,

Lawford²,

Wilson³

et al. 2018

J Midwife Womens Health

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Introduction Little is known about the relationship between distance from hospital services and the outcomes of planned home births. We examined whether greater driving distance from a hospital with continuous cesarean capability was associated with a higher risk of adverse neonatal outcome among individuals who were planning to give birth at home. Methods Using an intention‐to‐treat analysis, we conducted a population‐based cohort study of 11,869 individuals who planned to give birth at home in Ontario, Canada, between April 1, 2012, and March 31, 2015. We used postal codes to determine the driving time from maternal residence to the closest hospital offering level 2 or higher maternity care services (ie, hospital with continuous cesarean birth capability). We used log binomial regression analysis to compare the outcomes of individuals who planned a birth more than a 30‐minute drive from a level 2 hospital with those of individuals whose births were planned to occur within 30 minutes. We adjusted for maternal age, parity, gestational age, season, and maternal material deprivation quintile. Results We found no statistically significant difference in the rates of 5‐minute Apgar scores less than 7 (adjusted relative risk [aRR], 1.02; 95% CI, 0.95‐1.10; P = .58), perinatal mortality, meconium aspiration syndrome, and emergency medical service usage. Neonates born to individuals who planned to give birth at a greater distance from a hospital had a lower rate of neonatal intensive care unit admission (aRR, 0.6; 95% CI, 0.44‐0.81; P = .001). Discussion We found no increased risk of adverse neonatal outcomes for births that were planned to occur more than 30 minutes from a hospital. Our findings can be considered, along with individual risk factors and contextual factors, in decision making about the choice of home birth for individuals who live more than half an hour from a hospital with cesarean capacity.

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Remote rural women's choice of birthplace and transfer experiences in rural Otago and Southland New Zealand

Cited by 8 publications

References 55 publications

Women’s experiences of decision-making and informed choice about pregnancy and birth care: a systematic review and meta-synthesis of qualitative research

Women’s experiences of decision-making and informed choice about pregnancy and birth care: a systematic review and meta-synthesis of qualitative research

Access and outcomes of general practitioner obstetrician (rural generalist)‐supported birthing units in Queensland

Distance from Home Birth to Emergency Obstetric Services and Neonatal Outcomes: A Cohort Study

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