Midwife-assisted planned home birth: an essential component of improving the safety of childbirth in Sub-Saharan Africa

2018 ◽  
Vol 47 (1) ◽  
pp. 16-21 ◽  
Author(s):  
Aliyu Labaran Dayyabu ◽  
Yusuf Murtala ◽  
Amos Grünebaum ◽  
Laurence B. McCullough ◽  
Birgit Arabin ◽  
...  
Keyword(s):  
Perinatal Mortality ◽  
Developing World ◽  
Home Birth ◽  
Sub Saharan Africa ◽  
Ethical Challenges ◽  
Home Births ◽  
Mortality And Morbidity ◽  
Sub Saharan ◽  
Hospital Births ◽  
Planned Home Birth

Abstract Hospital births, when compared to out-of-hospital births, have generally led to not only a significantly reduced maternal and perinatal mortality and morbidity but also an increase in certain interventions. A trend seems to be emerging, especially in the US where some women are requesting home births, which creates ethical challenges for obstetricians and the health care organizations and policy makers. In the developing world, a completely different reality exists. Home births constitute the majority of deliveries in the developing world. There are severe limitations in terms of facilities, health personnel and deeply entrenched cultural and socio-economic conditions militating against hospital births. As a consequence, maternal and perinatal mortality and morbidity remain the highest, especially in Sub-Saharan Africa (SSA). Midwife-assisted planned home birth therefore has a major role to play in increasing the safety of childbirth in SSA. The objective of this paper is to propose a model that can be used to improve the safety of childbirth in low resource countries and to outline why midwife assisted planned home birth with coordination of hospitals is the preferred alternative to unassisted or inadequately assisted planned home birth in SSA.

scholarly journals Obstructed labour in a Nigerian tertiary health facility: a mixed-method study

2021 ◽  
Vol 10 (8) ◽  
pp. 2937
Author(s):  
Akaninyene Eseme Ubom ◽  
Omotade Adebimpe Ijarotimi ◽  
Ifeoluwa Emmanuel Ogunduyile ◽  
Ayobami Omilakin ◽  
Solomon Nyeche ◽  
...  
Keyword(s):  
Perinatal Mortality ◽  
Birth Asphyxia ◽  
Case Fatality ◽  
Sub Saharan Africa ◽  
University Teaching ◽  
Teaching Hospitals ◽  
Mortality And Morbidity ◽  
Obstructed Labour ◽  
Sub Saharan ◽  
University Teaching Hospitals

Background: Obstructed labour remains a leading cause of maternal and perinatal mortality and morbidity in sub-Saharan Africa. This study aimed to determine the incidence, causes, complications and outcomes of obstructed labour at the Obafemi Awolowo University Teaching Hospitals Complex (OAUTHC), Ile-Ife, Osun state, Nigeria.Methods: A mixed methods approach was employed for this study. A 10-year retrospective review of all cases of obstructed labour managed at the OAUTHC, between January 1, 2008, and December 31, 2017, was done. Ten in-depth interviews were conducted for some selected patients. The quantitative data was analysed using SPSS version 24, while the qualitative data was analyzed with NVivo version 12.Results: The incidence of obstructed labour was 1.99%. Most of the patients were unbooked (217, 90.4%), primigravid (138, 57.5%), and either had no formal or only primary/secondary education (120, 50%). Cephalopelvic disproportion (CPD) was the commonest cause of obstructed labour (227, 94.6%). The most common maternal complication was wound infection (48, 20%). There were three maternal deaths, giving a case fatality rate of 1.25%. The most common foetal complication was birth asphyxia (85, 34.7%). The perinatal mortality rate was 18.8 %. From the qualitative arm of the study, reasons given by parturients who suffered obstructed labour, for avoiding hospitals for delivery, included religion, finance, fear of hospitals, faith/belief in mission homes/maternity houses, and proximity.Conclusions: Obstructed labour remains an important obstetric problem in our environment, contributing significantly to the burden of maternal and perinatal mortality and morbidity. 

scholarly journals Notes on home birth: Safety, interventionism and satisfaction

2020 ◽  
Author(s):  
Marc Cruellas ◽  
Fina Martinez Soler ◽  
Avelina Tortosa ◽  
Pepita Gimenez-Bonafe
Keyword(s):  
Practice Guidelines ◽  
Good Practice ◽  
Home Birth ◽  
Developed Countries ◽  
Systematic Research ◽  
Maternal Outcomes ◽  
Controversial Topic ◽  
Hospital Births ◽  
Planned Home Birth ◽  
Unusual Situation

Abstract Background: Home birth is still considered an unusual situation on most developed countries, where it accounts between 0.2 and 25 percent of all births depending of the country. However, the safety of the process and whether it should be offered as a choice makes it a controversial topic with strong opinions on both sides. This review aims to describe the situation of home birth in several developed countries and debate its safety and mothers’ satisfaction, by reviewing studies that compare home vs. hospital births.Methods: A systematic research has been done using different search engines to find publications that portray the current situation on this topic. Protocols and historical facts were selected using no filters, while publications reporting maternal and birth outcomes, as well as levels of satisfaction, were selected using filters that limited the search to articles that had been published in the last 10 years. A total of 45 articles were selected and reviewed.Results: Home birth in each country depends on many factors, including historical and cultural. Some countries have either developed good practice guidelines or included home birth on the already existing ones, while some other countries still do not recognize it as a safe option. While most studies do not show significant differences on neonatal mortality APGAR score and intensive care admissions, they do describe slightly better maternal outcomes on home birth due to lower interventionism. Studies also show that between 13 and 29 percent of home births require transferring the woman or the fetus to the hospital. Satisfaction levels also appear to be higher in women who had a planned home birth.Conclusions: Home birth appears to be a safe choice for women with low risk pregnancies, due to a lower rate of interventionism. However, safety depends on many factors, from professional accreditation, to the presence of protocols and good practice guidelines. Satisfaction also appears to be higher on women who had a planned home birth, although it depends on personal considerations and circumstances.

scholarly journals The Canadian birth place study: examining maternity care provider attitudes and interprofessional conflict around planned home birth

2021 ◽  
Author(s):  
Saraswathi Vedam ◽  
Kathrin Stoll ◽  
Laura Schummers ◽  
Nichole Fairbrother ◽  
Michael C Klein ◽  
...  
Keyword(s):  
Care Provider ◽  
Home Birth ◽  
Outcome Variable ◽  
Categorical Variables ◽  
Provider Type ◽  
Provider Attitudes ◽  
Home Births ◽  
Birth Place ◽  
Obstetric Emergencies ◽  
Planned Home Birth

Background Available birth settings have diversified in Canada since the integration of regulated midwifery. Midwives are required to offer eligible women choice of birth place; and 25-30% of midwifery clients plan home births. Canadian provincial health ministries have instituted reimbursement schema and regulatory guidelines to ensure access to midwives in all settings. Evidence from well-designed Canadian cohort studies demonstrate the safety and efficacy of midwife-attended home birth. However, national rates of planned home birth remain low, and many maternity providers do not support choice of birth place. Methods In this national, mixed-methods study, our team administered a cross-sectional survey, and developed a 17 item Provider Attitudes to Planned Home Birth Scale (PAPHB-m) to assess attitudes towards home birth among maternity providers. We entered care provider type into a linear regression model, with the PAPHB-m score as the outcome variable. Using Students’ t tests and ANOVA for categorical variables and correlational analysis (Pearson’s r) for continuous variables, we conducted provider-specific bivariate analyses of all socio-demographic, education, and practice variables (n=90) that were in both the midwife and physician surveys. Results Median favourability scores on the PAPHB–m scale were very low among obstetricians (33.0), moderately low for family physicians (38.0) and very high for midwives (80.0), and 84% of the variance in attitudes could be accounted for by care provider type. Amount of exposure to planned home birth during midwifery or medical education and practice was significantly associated with favourability scores. Concerns about perinatal loss and lawsuits, discomfort with inter-professional consultations, and preference for the familiarity of the hospital correlated with less favourable attitudes to home birth. Among all providers, favourability scores were linked to beliefs about the evidence on safety of home birth, and confidence in their own ability to manage obstetric emergencies at a home birth. Conclusions Increasing the knowledge base among all maternity providers about planned home birth may increase favourability. Key learning competencies include criteria for birth site selection, management of obstetric emergencies at planned home births, critical appraisal of literature on safety of home birth, and inter-professional communication and collaboration when women are transferred from home to hospital.

scholarly journals NAČRTOVAN POROD NA DOMU: PREGLEDNI ČLANEK

2016 ◽  
Vol 85 (3) ◽  
Author(s):  
Tamara Serdinšek ◽  
Iztok Takač
Keyword(s):  
United Kingdom ◽  
The Netherlands ◽  
Home Birth ◽  
The United States ◽  
Home Births ◽  
Mortality And Morbidity ◽  
Advantages And Disadvantages ◽  
Birth Attendants ◽  
Definition Of ◽  
At Home

Background: Home birth is as old as humanity, but still most middle- and high-income countries consider hospitals as the safest birth settings, as complications regarding birth are highly unpredictable. Despite this there are a few countries in which home birth in integrated into official healthcare system (the Netherlands, United Kingdom, Canada etc.). Home births can be divided into unplanned and planned, and the latter can be further categorized by the presence of the birth attendants. This review focuses on planned home births, which are differently represented throughout the world. In the United States 0.6-1.0% of all children are born at home, in the United Kingdom 2-3%, in Canada 1.6% and in the Netherlands 20-30%. For Slovenia, the number of planned home births is unknown; however, in 2010 0.1% of children were born outside medical facilities.Conclusions: The safety of home birth in still under the debate. While research confirms smaller number of obstetric interventions and some complications in mothers who give birth at home, the data regarding the neonatal and perinatal mortality and morbidity is still conflicting. This confirms the need for large multicentric trials in this field. Current home birth guidelines emphasize that women should be well informed regarding the possible advantages and disadvantages of home births. In addition, the emphasis is on definition of selection criteria for home birth, indications for intrapartal transfer to the hospital and appropriate education of birth attendants. 

scholarly journals The challenges of managing breast cancer in the developing world – a perspective from sub-Saharan Africa

2014 ◽  
Vol 104 (5) ◽  
pp. 377 ◽  
Author(s):  
Jenny Edge ◽  
Ines Buccimazza ◽  
Herbert Cubasch ◽  
Eugenio Panieri
Keyword(s):  
Breast Cancer ◽  
Developing World ◽  
Sub Saharan Africa ◽  
Sub Saharan

scholarly journals Female Nutritional Status across the Life-Span in Sub-Saharan Africa. 2. Causes and Consequences

1997 ◽  
Vol 18 (1) ◽  
pp. 1-12
Author(s):  
Joanne Leslie ◽  
Suzanne Bibi Essama ◽  
Elizabeth Ciemins
Keyword(s):  
Nutritional Status ◽  
Sub Saharan Africa ◽  
African Women ◽  
Negative Consequences ◽  
Mortality And Morbidity ◽  
Nutritional Deprivation ◽  
Child Bearing ◽  
Adaptive Mechanisms ◽  
Sub Saharan ◽  
Intensive Work

This article reviews existing data concerning the causes and consequences of female malnutrition in sub-Saharan Africa. As in most parts of the world, the primary cause of female malnutrition is household food insecurity compounded by low household and individual incomes. Gender-specific factors that further undermine women's nutritional status are the severe physiological burden of frequent child-bearing and the continuous long hours of energy-intensive work. Negative consequences of malnutrition among females include high rates of mortality and morbidity, impaired learning, low birthweights, and reduced energy for discretionary activities. We question the conclusion of other studies that African women have developed special “adaptive mechanisms” to compensate for nutritional deprivation, and recommend that further research investigate the hidden individual and societal costs of malnutrition among women.

scholarly journals High infectious disease burden as a basis for the observed high frequency of asymptomatic SARS-CoV-2 infections in sub-Saharan Africa

2021 ◽  
Vol 4 ◽  
pp. 2
Author(s):  
Kwadwo Asamoah Kusi ◽  
Augustina Frimpong ◽  
Frederica Dedo Partey ◽  
Helena Lamptey ◽  
Linda Eva Amoah ◽  
...  
Keyword(s):  
North America ◽  
Severe Acute Respiratory Syndrome ◽  
Sub Saharan Africa ◽  
World Health ◽  
Susceptible Population ◽  
Mortality And Morbidity ◽  
Quality Healthcare ◽  
The World ◽  
Sub Saharan ◽  
Health Organization

Following the coronavirus outbreaks described as severe acute respiratory syndrome (SARS) in 2003 and the Middle East respiratory syndrome (MERS) in 2012, the world has again been challenged by yet another corona virus, named severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). SARS-CoV-2 infections were first detected in a Chinese Province in December 2019 and then declared a pandemic by the World Health Organization in March 2020. An infection caused by SARS-CoV-2 may result in asymptomatic, uncomplicated or fatal coronavirus disease 2019 (COVID-19). Fatal disease has been linked with the uncontrolled “cytokine storm” manifesting with complications mostly in people with underlying cardiovascular and pulmonary disease conditions. The severity of COVID-19 disease and the associated mortality has been disproportionately lower in Africa and Asia in comparison to Europe and North America in terms of number of cases and deaths. While persons of colour who live in Europe and North America have been identified as a highly susceptible population due to a combination of several socioeconomic factors and poor access to quality healthcare, this has not been the case in sub-Saharan Africa where inhabitants are even more deprived concerning the said factors. On the contrary, sub-Saharan Africa has recorded the lowest levels of mortality and morbidity associated with the disease, and an overwhelming proportion of infections are asymptomatic. This review discusses the most probable reasons for the significantly fewer cases of severe COVID-19 disease and deaths in sub-Saharan Africa.

scholarly journals Maternal and Perinatal Mortality in the 21st Century

2016 ◽  
Vol 10 (2) ◽  
pp. 143-146
Author(s):  
Aris Antsaklis
Keyword(s):  
Perinatal Mortality ◽  
21St Century ◽  
Maternal Mortality Ratio ◽  
Geographic Area ◽  
Developed Countries ◽  
Sub Saharan Africa ◽  
Maternal Deaths ◽  
Neonatal Deaths ◽  
Live Births ◽  
Sub Saharan

ABSTRACT The maternal mortality ratio measures how safe it is to become pregnant and give birth in a geographic area or a population. The total number of maternal deaths observed annually fell from 526,000 in 1980 to 358,000 in 2008, a 34% decline over this period. Similarly, the global MMR declined from 422 in 1980 to 320 in 1990 and was 250 per 100,000 live births in 2008, a decline of 34% over the entire period and an average annual decline of 2.3%. More specifically, in 1990 around 58% of maternal deaths worldwide occurred in Asia and 36% in sub-Saharan Africa. In contrast, in 2008, 57% of global maternal deaths occurred in sub-Saharan Africa and 39% in Asia. In Europe, the main causes of death from any known direct obstetric complication remains bleeding (13%), thromboembolic events (10.1%), complicationassociated birth, hypertensive disease of pregnancy (9.2%), and amniotic fluid embolism (10.6%). Preterm birth is the most common cause of perinatal mortality (PNM) causing almost 30% of neonatal deaths, while birth defects cause about 21% of neonatal deaths. The PNM rate refers to the number of perinatal deaths per 1,000 total births. Perinatal mortality rate may be below 10 for certain developed countries and more than 10 times higher in developing countries. Perinatal health in Europe has improved dramatically in recent decades. In 1975, neonatal mortality ranged from 7 to 27 per 1,000 live births in the countries that now make up the EU. By 2005, it had declined to 8 per 1,000 live births. We need to bring together data from civil registration, medical birth registers, hospital discharge systems in order to have European Surveys which present exciting research possibilities. How to cite this article Antsaklis A. Maternal and Perinatal Mortality in the 21st Century. Donald School J Ultrasound Obstet Gynecol 2016;10(2):143-146.

Sign in / Sign up

Export Citation Format

Share Document