Determinants of Place Birth: A Multinomial Logistic Regression and Spatial Analysis of the 2019 Ethiopian Mini Demographic and Health Survey Data

Background: The presence of skilled attendants at birth and institutional delivery with quality serves significantly improves maternal and neonatal health. However, in countries where a practice of home birth is common, maternal and neonatal mortality remained high. Thus, this study aimed to determine the spatial distribution of home birth and to identify determinants of place of birth in Ethiopia. Methods: Ethiopian mini-DHS-2019 data was used in this analysis. A survey multinomial logistic regression model was used to analyze determinants of place of birth. An adjusted relative risk ratio and its 95% confidence interval with a p-value of < 0.05 and marginal effect and its 95% confidence interval with a p-value of < 0.05 were used to declare statistical significance. The Global Moran’s I analysis was done by using ArcMap 10.8 to evaluate the clustering of home birth. The magnitude of home birth was predicted by ordinary kriging interpolation. Then, scanning was done by SaTScan V.9.6 software to detect scanning windows with low or high rates of home birth. Result: Prevalence of home birth in Ethiopia was 52.19% (95% CI: 46.49 – 57.83). Whereas, only 2.99% (95% CI: 1.68 – 5.25) of mothers gave birth in the health posts. Bigger family size, family wealth, multiparity, none and fewer antenatal visits, and low cluster level coverage of 4+ antenatal visits were predictors of home birth. Homebirth was clustered across enumeration areas and it was over 40% in most parts of the country with >75% in the Somali region. SaTScan analysis detected most likely clusters in the Somali region, eastern and southern zones of Oromia region, central zones of Amhara region, and eastern zones of the South Nations Nationalities and People’s region. Conclusion: Home birth is a common practice in Ethiopia. Among public health facilities, health posts are the least utilized institutions for labor and delivery care. Nationally implementing the 2016 WHO’s recommendations on antenatal care for a positive pregnancy experience and providing quality antenatal and delivery care in public facilities through qualified providers with midwifery skills and systems of back-up in place could be supportive.

Influence of Socio-Economic Factors on Choice of Childbirth Place Among Women In Oyigbo L.G.A., Rivers State, Nigeria

BACKGROUND: Choices of childbirth places among women may influence the rate of maternal risks and some social and economic factors which encourage maternal mortality are still a major challenge especially in developing countries like Nigeria, one of the commonest of these childbirth place choices is home birth. The aim of this study was to find out the prevalent socio-economic factors that influence the choice of childbirth places among the women of child bearing age in Oyigbo Local Government area of Rivers State in Nigeria.METHODOLOGY: A self-structured questionnaire was used as instrument to collect data for the study through simple random sampling, and these data was analyzed using Frequency and percentage for descriptive statistics while chi-square was used for inferential statistics at 0.05 level of significance. RESULT: The result showed that mean age of the women is 35.27 and most of them had secondary education, also there was a high level of hospital/health facility adherence among the women in Oyigbo Local Government Area of Rivers State and there were no significant association between social factors and choices of childbirth places among the women, and also there was significant associations between income and choices of childbirth places among the women but there were no significant association between the educational qualifications and choices of childbirth places among the women.CONCLUSION: There is a slight influence of social factors on the choices women make on childbirth places, since maternal health and antenatal knowledge is now easily accessible to everyone even without formal education, however, the cost implication of delivery in health facility and economic empowerment of women should be considered, therefore this study has shown that the choice of childbirth place is majorly influenced by their level of income.

New Zealand midwives' management of perineal trauma during childbirth: A survey of practice

<p>Background: Perineal trauma is the most common complication of vaginal birth and how this is treated has an impact on the incidence and duration of pain and dysfunction. Responsibility for the management of women’s perinea after uncomplicated births in New Zealand ordinarily rests with midwives although this is a little known aspect of practice. This study aimed to identify how midwives assess and manage second degree perineal trauma, the level to which their practice reflects best evidence, and what influences midwives’ decision-making. Methods: A descriptive approach using an online survey of 75 questions was used to access the population of 2910 New Zealand midwives. Inclusion criterion was current perineal management. Quantitative data were collected and associations examined using chi-square and Fisher’s exact test. Interval data were analysed with a two-sample t-test. Results: 818 midwives returned a questionnaire, 744 (25% of the midwifery population) met the inclusion criteria. Evidence-based suturing material for repair of the last second degree tear was used by 96%. Correct suturing technique throughout all layers of repair was 42%. Rectal examination during assessment was performed by 45% increasing to 86% after repair. Confidence to repair was directly related to years since midwifery qualification (p<.001) and self-employment (p<.001). The tear was left unsutured by 7% and associated with reduced confidence with repair (p<.001), lack of recent experience with repair (p<.001), and home birth (p=.002). Unsutured tears were shorter than sutured tears (vaginal/perineal length, p<.001; depth, p=.004) and associated with delayed healing (p=.034). Care to six weeks postpartum was provided by 377 midwives. Perineal analgesia included oral medication (76%), pelvic floor exercises (44%), cooling (38%), and suppositories (31%). Visual assessments of healing were performed by 84% of midwives, 49% of women, and 7% of support people. Complications of infection (2%), pain (2%), and healing delay (3%) were uncommon. Conclusions: This research has added a New Zealand midwifery practice perspective to the existing literature on second degree perineal care. Potential for reductions in perineal morbidity were identified, even though New Zealand midwifery care already has a low rate of complications compared to international studies.</p>

New Zealand midwives' management of perineal trauma during childbirth: A survey of practice

<p>Background: Perineal trauma is the most common complication of vaginal birth and how this is treated has an impact on the incidence and duration of pain and dysfunction. Responsibility for the management of women’s perinea after uncomplicated births in New Zealand ordinarily rests with midwives although this is a little known aspect of practice. This study aimed to identify how midwives assess and manage second degree perineal trauma, the level to which their practice reflects best evidence, and what influences midwives’ decision-making. Methods: A descriptive approach using an online survey of 75 questions was used to access the population of 2910 New Zealand midwives. Inclusion criterion was current perineal management. Quantitative data were collected and associations examined using chi-square and Fisher’s exact test. Interval data were analysed with a two-sample t-test. Results: 818 midwives returned a questionnaire, 744 (25% of the midwifery population) met the inclusion criteria. Evidence-based suturing material for repair of the last second degree tear was used by 96%. Correct suturing technique throughout all layers of repair was 42%. Rectal examination during assessment was performed by 45% increasing to 86% after repair. Confidence to repair was directly related to years since midwifery qualification (p<.001) and self-employment (p<.001). The tear was left unsutured by 7% and associated with reduced confidence with repair (p<.001), lack of recent experience with repair (p<.001), and home birth (p=.002). Unsutured tears were shorter than sutured tears (vaginal/perineal length, p<.001; depth, p=.004) and associated with delayed healing (p=.034). Care to six weeks postpartum was provided by 377 midwives. Perineal analgesia included oral medication (76%), pelvic floor exercises (44%), cooling (38%), and suppositories (31%). Visual assessments of healing were performed by 84% of midwives, 49% of women, and 7% of support people. Complications of infection (2%), pain (2%), and healing delay (3%) were uncommon. Conclusions: This research has added a New Zealand midwifery practice perspective to the existing literature on second degree perineal care. Potential for reductions in perineal morbidity were identified, even though New Zealand midwifery care already has a low rate of complications compared to international studies.</p>

Global stakeholder perspectives of home birth: a systematic scoping review

Home birth is experienced by people very differently worldwide. These experiences likely differ by the type of stakeholder involved (women, their support persons, birth attendants, policy-makers), the experience itself (low-risk birth, transfer to hospital, previous deliveries), and by the health system within which home birth occurs (e.g., high-resource versus low- and middle-resource countries). Research evidence of stakeholders’ perspectives of home birth could usefully inform personal and policy decisions about choosing and providing home birth, but the current literature is fragmented and its breadth is not fully understood.We conducted a systematic scoping review to understand how the research literature on stakeholders’ perspectives of home birth is characterized in terms of populations, settings and identified issues, and what potential gaps exist in the research evidence. A range of electronic, web-based and key informant sources of evidence were searched. Located references were assessed, data extracted, and descriptively analyzed using robust methods.Our analysis included 460 full reports. Findings from 210 reports of studies in high-resource countries suggested that research with fathers and same-sex partners, midwives, and vulnerable populations and perspectives of freebirth and transfer to hospital could be synthesized. Gaps in primary research exist with respect to family members, policy makers, and those living in rural and remote locations. A further 250 reports of studies in low- and middle-resource countries suggested evidence for syntheses related to fathers and other family members, policy makers, and other health care providers and examination of issues related to emergency transfer to hospital, rural and remote home birth, and those who birth out of hospital, often at home, despite receiving antenatal care intended to increase healthcare-seeking behavior. Gaps in primary research suggest an examination is needed of perspectives in countries with higher maternal mortality and among first-time mothers and young mothers.Our scoping review identified a considerable body of research evidence on stakeholder perspectives of home birth. These could inform the complex factors influencing personal decisions and health system planning around home birth in both high- and low- and middle-resource countries. Future primary research is warranted on specific stakeholders worldwide and with vulnerable populations in areas of high maternal mortality.

A review of third stage of labour care guidance

Introduction Concerns exist regarding the suitability of national and international guidance informing third stage of labour care for women at low risk of postpartum haemorrhage. Methods The robustness and appropriateness of the research evidence underpinning third stage of labour care guidance by institutions such as the National Institution for Health and Care Excellence, the Royal College of Obstetricians and Gynaecologists and the Royal College of Midwives was assessed and areas for further research to address any gaps in knowledge were identified. Results National and international third stage of labour practice guidance recommend active management for all women. This may not be suitable for women at low risk of postpartum haemorrhage giving birth in a midwife-led unit or a home birth setting. This is because of the reduced reliability, validity and generalisability of the evidence informing this guidance to this group of women. Conclusions Expectant management may be more appropriate for women at low risk of postpartum haemorrhage who choose to birth in a midwife-led unit or home birth setting and want to experience a birth with minimal intervention. However, more research into third stage management practices in these settings is needed.

The Cost of Home Birth in the United States

Policy decisions about the accessibility of home birth hinge on questions of safety and affordability. Families consider safety and cost along with the comfort and familiarity of birthing venues. A substantial literature addresses safety concerns, generally reporting that for low-risk mothers in the care of credentialed midwives, the safety of planned home births is comparable to that in birth centers and hospitals. The lack of notable safety tradeoffs for low-risk mothers elevates the relevance of the economic efficiency of home births. The available cost figures for home births are largely out of date or anecdotal. The purpose of this research is to offer scholars, policymakers, and families improved estimates of both the cost of home births and the potential savings from greater access to home births. On the basis of a nationwide study, we estimate that the average cost of a home birth in the United States is USD 4650, which is significantly below existing cost estimates for an uncomplicated birth center or hospital birth. Further, we find that each shift of one percent of births from hospitals to homes would represent an annual cost savings to society of at least USD 321 million.

Concerns about transmission, changed services and place of birth in the early COVID-19 pandemic: a national survey among Danish pregnant women. The COVIDPregDK study

Background The outbreak of the COVID-19 pandemic caused great uncertainty about causes, treatment and mortality of the new virus. Constant updates of recommendations and restrictions from national authorities may have caused great concern for pregnant women. Reports suggested an increased number of pregnant women choosing to give birth at home, some even unassisted (‘freebirth’) due to concerns of transmission in hospital or reduction in birthplace options. During April and May 2020, we aimed to investigate i) the level of concern about coronavirus transmission in Danish pregnant women, ii) the level of concern related to changes in maternity services due to the pandemic, and iii) implications for choice of place of birth. Methods We conducted a nationwide cross-sectional online survey study, inviting all registered pregnant women in Denmark (n = 30,009) in April and May 2020. Results The response rate was 60% (n = 17,995). Concerns of transmission during pregnancy and birth were considerable; 63% worried about getting severely ill whilst pregnant, and 55% worried that virus would be transmitted to their child. Thirtyeight percent worried about contracting the virus at the hospital. The most predominant concern related to changes in maternity services during the pandemic was restrictions on partners’ attendance at birth (81%). Especially nulliparous women were concerned about whether cancelled antenatal classes or fewer physical midwifery consultations would affect their ability to give birth or care for their child postpartum.. The proportion of women who considered a home birth was equivalent to pre-pandemic home birth rates in Denmark (3%). During the temporary discontinue of public home birth services, 18% of this group considered a home birth assisted by a private midwife (n = 125), and 6% considered a home birth with no midwifery assistance at all (n = 41). Conclusion Danish pregnant womens’ concerns about virus transmission to the unborn child and worries about contracting the virus during hospital appointments were considerable during the early pandemic. Home birth rates may not be affected by the pandemic, but restrictions in home birth services may impose decisions to freebirth for a small proportion of the population.

The Scope of the Right to Give Birth at Home as Reproductive Self-determination In the Legislation of Georgia and the Practice of the European Court of Human Rights

This article discusses the scope of the right to give birth at home as reproductive self-de- termination in the context of Georgian law and the case-law of the European Court. Georgia, like many other member states of the Council of Europe, unconditionally prefers the model of hospital delivery to protect maternal and fetal life and health. It is true that under Georgian law, home birth is not prohibited as such, however except for emergencies, medical staff is authorized to provide medical care only in a licensed medical premise. That equates to a restriction of the right. Despite the legitimate interest in restricting the right to give birth at home, scientific studies have confirmed the similarity between the consequences of home birth and hospital delivery in the case of low-risk pregnancies. The blanket ban on the right to give birth at home became the object of debate in the European Court in 2010. The court explained that the right to respect for private life enshrined in the Convention includes not only a person’s decision to become or not to become a parent, but also the choice of conditions. According to the court, childbirth is a unique and delicate moment in a woman’s life, and the determination of the place of childbirth is fundamentally related to a woman’s personal life. The European Court has discussed the availability and foreseeability of national legislation in the context of restricting the right to give birth at home. The Court has ruled that national authorities must ensure the clarity (if any) of the responsibility for providing obstetric services at home. However, the Court has still left open the issue of the need to restrict the right to give birth at home on the grounds of a lack of consensus among the member states of the Council of Europe and the complex socio-economic aspects of the issue.