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

2014 ◽  
Vol 14 (1) ◽  
Author(s):  
Saraswathi Vedam ◽  
Kathrin Stoll ◽  
Laura Schummers ◽  
Nichole Fairbrother ◽  
Michael C Klein ◽  
...  
Keyword(s):  
Care Provider ◽  
Maternity Care ◽  
Home Birth ◽  
Provider Attitudes ◽  
Birth Place ◽  
Planned Home Birth

scholarly journals Planned Home Birth in Low-Risk Pregnancies in Spain: A Descriptive Study

2021 ◽  
Vol 18 (7) ◽  
pp. 3784
Author(s):  
Trinidad M. Galera-Barbero ◽  
Gabriel Aguilera-Manrique
Keyword(s):  
Home Birth ◽  
Newborn Health ◽  
Well Being ◽  
Balearic Islands ◽  
Low Risk ◽  
Maternal And Newborn Health ◽  
Home Births ◽  
Hospital Transfer ◽  
Maternal And Neonatal Health ◽  
Planned Home Birth

Previous studies have shown that planned home birth in low-risk pregnancies is a generally safe option. However nowadays, only 0.5 percent of deliveries have been at home in Spain. This study sought to understand the characteristics of planned home births with qualified healthcare professionals in low-risk pregnancies and their results on maternal and neonatal health in the Balearic Islands. The study followed a retrospective descriptive design to investigate planned home births from 1989 to 2019 (n = 820). Sociodemographic data of women, healthcare professional intervention rates, and maternal/fetal morbidity/mortality results were collected. Statistical analysis of the results was performed using the IBM SPSS Version 25 software package. The results indicated that women with low-risk pregnancies who planned home births with a qualified midwife had a higher probability of spontaneous vaginal birth delivery and positive maternal health results. Furthermore, the risk of hospital transfer was low (10.7%) and the rate of prolonged breastfeeding (>1 year) was extremely high (99%). Moreover, the study showed that planned home births can be generally associated with fetal well-being. The conclusions and implications of this study are that planned home births in low-risk pregnancies attended by qualified midwives in the Balearic Islands achieve positive results in both maternal and newborn health, as well as low rates of obstetric intervention.

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 “Se estava tudo bem, porque é que eu havia de ir a uma obstetra?”: identidade, risco e consumo de tecnologia médica no parto domiciliar em Portugal

2016 ◽  
Vol 2016 (82) ◽  
Author(s):  
Mário J. D. S. Santos ◽  
Amélia Augusto
Keyword(s):  
Risk Perceptions ◽  
Mystical Experience ◽  
Medical Knowledge ◽  
Home Birth ◽  
Home Births ◽  
Medical Risk ◽  
Medical Technologies ◽  
Planned Home Birth ◽  
Empirical Field ◽  
Pregnancy And Birth

Contemporary home births are rare and quite invisible phenomena, and quite unexplored as an empirical field. From interviewing women and couples who experienced a planned home birth, this article aims to give an initial sociological portrait of this phenomenon in Portugal. It is shown to be not a return of the traditional or a search for a mystical experience, but rather a physical and concrete happening, strongly shaped by scientific and medical knowledge, within a search for identity coherence. Several social and medical risk perceptions emerged, as well as a reflexive consumption of medical technologies framed by these same perceptions. Despite the fact that home birth detracts the relevance of medicine during pregnancy and birth, it is not possible to frame it as a phenomenon of demedicalisation.

scholarly journals Follow-Up Rates at a Free Ophthalmology Clinic at a Homeless Shelter

2021 ◽  
Vol 13 (01) ◽  
pp. e51-e56
Author(s):  
Lauren Hennein ◽  
Kimberly A. Spaulding ◽  
Veronika Karlegan ◽  
Ogonna N. Nnamani Silva ◽  
Alejandra G. de Alba Campomanes
Keyword(s):  
High School ◽  
Primary Care ◽  
Care Provider ◽  
Primary Care Provider ◽  
Nonprofit Organization ◽  
County Hospital ◽  
Categorical Variables ◽  
Homeless Shelter ◽  
High School Diploma

Abstract Objective Eye health among the homeless community is important, as poor vision makes this population vulnerable and adds significantly to the social and health burden. There is limited knowledge on patient follow-up rates for their eye conditions and barriers to accessing care in this population. The purpose of this retrospective chart review study is to examine follow-up rates and barriers to care for patients referred from a free, medical-student run ophthalmology clinic at a homeless shelter. Methods All patients evaluated at a free ophthalmology clinic from September 2017 to September 2018 were included; no patients were excluded. If indicated, patients were referred for advanced ophthalmologic care at a local county hospital and free eyeglasses at a nonprofit organization. Primary outcomes were follow-up rates at the county hospital and nonprofit organization. Secondary outcomes included prespecified baseline variables hypothesized to be associated with follow-up rates. These categorical variables were compared with Chi-square testing to determine their association with follow-up rates. The hypothesis being tested was formulated before data collection. Results Of the 68 patients, 84% were males with a mean age of 50 years. Overall, 40 patients were referred for free eyeglasses and 17 to the county hospital. Of those referred, 14 patients presented for free eyeglasses and 7 presented to the county hospital. About 79% of patients with a pre-established primary care provider presented to their appointment compared with 20% of those without one (p = 0.03). The 44% of patients with a high school diploma presented while all patients without a high school diploma failed to present (p = 0.04). Vision-threatening conditions identified at the shelter clinic did not affect follow-up rates (p = 0.79). Conclusion Less than half of referred patients in our study presented to their appointments. Barriers to presentation included no primary care provider and lower educational status, with no improvement in follow-up rates among those referred for vision-threatening conditions. Interventions such as health coaching with particular attention to educating patients on the effects of vision-threatening conditions may be warranted, particularly for those not looped into the health care system and those of lower educational attainment.

Obstetric Ethics: An Essential Dimension in Planned Home Birth

2011 ◽  
Vol 118 (2, Part 1) ◽  
pp. 357 ◽  
Author(s):  
Nicholas S. Fogelson ◽  
Stuart Fischbein
Keyword(s):  
Home Birth ◽  
Essential Dimension ◽  
Planned Home Birth

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.

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