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1.
Am J Perinatol ; 37(10): 1038-1043, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32498092

RESUMO

With the coronavirus disease 2019 (COVID-19) pandemic in the United States, a majority of states have instituted "shelter-in-place" policies effectively quarantining individuals-including pregnant persons-in their homes. Given the concern for COVID-19 acquisition in health care settings, pregnant persons with high-risk pregnancies-such as persons living with HIV (PLHIV)-are increasingly investigating the option of a home birth. Although we strongly recommend hospital birth for PLHIV, we discuss our experience and recommendations for counseling and preparation of pregnant PLHIV who may be considering home birth or at risk for unintentional home birth due to the pandemic. We also discuss issues associated with implementing a risk mitigation strategy involving high-risk births occurring at home during a pandemic. KEY POINTS: · Coronavirus disease 2019 pandemic has increased interest in home birth.. · Women living with HIV are pursuing home birth.. · Safe planning is paramount for women living with HIV desiring home birth, despite recommending against the practice..


Assuntos
Infecções por Coronavirus/epidemiologia , Infecções por HIV/epidemiologia , Parto Domiciliar/métodos , Pandemias/prevenção & controle , Pneumonia Viral/epidemiologia , Resultado da Gravidez , Gravidez de Alto Risco , Adulto , Comorbidade , Infecções por Coronavirus/prevenção & controle , Aconselhamento , Parto Obstétrico/métodos , Feminino , Parto Domiciliar/estatística & dados numéricos , Humanos , Transmissão Vertical de Doença Infecciosa/prevenção & controle , Pandemias/estatística & dados numéricos , Segurança do Paciente/estatística & dados numéricos , Pneumonia Viral/prevenção & controle , Gravidez , Medição de Risco , Estados Unidos
2.
BMC Public Health ; 20(1): 796, 2020 May 27.
Artigo em Inglês | MEDLINE | ID: mdl-32460736

RESUMO

BACKGROUND: The World Health Organization estimates that globally only 43% of women have access to skilled care during deliveries and the rest are exposed to unskilled delivery service. A recent Ethiopian Demographic and Health Survey report stated that maternal death was 412 per 100,000 in 2016.This still indicates that maternal health remains a major public health problem in Ethiopia irrespective of the government's measure to institutional delivery. Therefore, the aim of this study was to assess the magnitude of home delivery and associated factors among women of child bearing age in Sherkole district, Western Ethiopia. METHODS: A community based cross sectional study was conducted among women aged 15-49 years in Sherkole district, Benishangul Gumuz region from January to June 2018. A total of 451 randomly selected women were included in the study. Stratified sampling followed by simple random sampling technique was used to select the study participants. Data were collected using pretested and structured questionnaires. Bivariate and multivariate logistic regression models were fitted to identify factors associated with home delivery among women in the child bearing age. An adjusted odds ratio with a 95% confidence interval was computed to determine the level of significance. RESULTS: The magnitude of home delivery was 353 (80%) and were assisted by non-skilled birth attendants. Mothers whose husband chooses the place of delivery [AOR: 5.6, 95% CI (2.1-15.2), Mothers' occupation ([AOR: 0.21 95% C I (0.08-0.57), ANC visit [AOR: 95 CI: 5.1(1.6-15.8), decision making [AOR: 95 CI: 0.3(0.01-0.7)] and traditional remedies [AOR: 95%CI: 0.03 (0.01-0.09)] were significantly associated with home delivery. CONCLUSIONS: Based on the findings of the survey, it was concluded that the overall magnitude of home delivery was found to be high. Therefore, it is recommended that the promotion of antenatal care follow-up with maternal and child health information particularly on delivery complications or danger signs needs due attention and remedial actions. In addition, it is indispensable introducing defaulter tracing mechanisms in ANC services, by learning from experiences of settings that have already adopted it.


Assuntos
Parto Obstétrico/estatística & dados numéricos , Parto Domiciliar/estatística & dados numéricos , Mães/estatística & dados numéricos , Cuidado Pré-Natal/estatística & dados numéricos , Adolescente , Adulto , Estudos Transversais , Tomada de Decisões , Etiópia , Feminino , Inquéritos Epidemiológicos , Humanos , Modelos Logísticos , Mortalidade Materna , Pessoa de Meia-Idade , Razão de Chances , Gravidez , População Rural/estatística & dados numéricos , Inquéritos e Questionários , Adulto Jovem
3.
Afr J Reprod Health ; 24(1): 143-151, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32358946

RESUMO

One intervention that is widely believed to reduce the high maternal mortality in resource-poor countries including Nigeria is delivery in health facilities under skilled birth attendance. However, the practice of non-facility delivery is still common in these countries. Curiously, women who attend ANC in health facilities are also among those who choose to deliver in a non-facility. This was a descriptive cross-sectional study conducted in Bali LGA of Taraba State, Nigeria. Multi-stage sampling technique was used to select 320 women of childbearing age who attended ANC and had had a recent delivery. The objective was to determine the factors associated with choice of non-facility delivery among women attending ANC in the area. Data analysis was done using EPI info computer software version 7.2.1.0 Most of the women (73.1%) delivered in a non-facility. Ethnicity and place of ANC were the predictors of non-facility delivery. The most common reason for non-facility delivery was that labour came without complications (58.8%). Prevalence of non-facility delivery in the area was disturbingly high. Strategies to discourage the practice should include providing adequate skilled personnel and equipment at all levels of healthcare. There should also be active engagement of the traditional and religious institutions in the area.


Assuntos
Parto Obstétrico , Parto Domiciliar/estatística & dados numéricos , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Preferência do Paciente , Cuidado Pré-Natal/estatística & dados numéricos , Adolescente , Adulto , Estudos Transversais , Parto Obstétrico/estatística & dados numéricos , Feminino , Instalações de Saúde , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Recém-Nascido , Trabalho de Parto , Governo Local , Nigéria , Gravidez , Gestantes , Inquéritos e Questionários
4.
PLoS One ; 15(5): e0233607, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32442234

RESUMO

INTRODUCTION: Birthing centres (BC) in Nepal are mostly situated in rural areas and provide care for women without complications. However, they are often bypassed by women and their role in providing good quality maternity services is overlooked. This study evaluated an intervention to increase access and utilisation of perinatal care facilities in community settings. METHODS: This longitudinal cross-sectional study was conducted over five years in four villages in Nepal and included two BCs. An intervention was conducted in 2014-2016 that involved supporting the BCs and conducting a health promotion programme with local women. Population-based multi-stage sampling of women of reproductive age with a child below 24 months of age was undertaken. Household surveys were conducted (2012 and 2017) employing trained enumerators and using a structured validated questionnaire. The collected data were entered into SPSS and analysed comparing pre- and post-intervention surveys. RESULTS: The intervention was associated with an increase in uptake in facility birth, with an increase in utilisation of perinatal services available from BCs. The post-intervention survey provided evidence that women were more likely to give birth at primary care facilities (OR 5.60, p-value <0.001) than prior to the intervention. Similarly, the likelihood of giving birth at a health facility increased if decision for birthplace was made jointly by women and family members for primary care facilities (OR 1.76, p-value 0.023) and hospitals/tertiary care facilities (OR 1.78, p-value 0.020. If women had less than four ANC visits, then they were less likely to give birth at primary care facilities (OR 0.39, p-value <0.001) or hospitals/tertiary care facilities (OR 0.63, p-value 0.014). Finally, women were less likely to give birth at primary care facilities if they had only primary level of education (OR 0.49, p-value 0.014). CONCLUSION: BCs have the potential to increase the births at health facilities and decrease home births if their services are promoted by the local health promoters. In addition, socio-economic factors including women's education, the level of women's autonomy and having four or more ANC visits affect the utilisation of perinatal services at the health facility.


Assuntos
Centros de Assistência à Gravidez e ao Parto/estatística & dados numéricos , Parto Obstétrico/estatística & dados numéricos , Promoção da Saúde , Cuidado Pré-Natal/estatística & dados numéricos , Adulto , Atitude Frente a Saúde , Estudos Transversais , Feminino , Acesso aos Serviços de Saúde , Parto Domiciliar/estatística & dados numéricos , Humanos , Recém-Nascido , Estudos Longitudinais , Tocologia , Nepal , Gravidez , População Rural , Inquéritos e Questionários , Adulto Jovem
5.
Obstet Gynecol ; 135(6): 1353-1361, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32459427

RESUMO

OBJECTIVE: To evaluate the difference in odds of cesarean delivery in term, singleton, vertex pregnancies between the midwife and obstetrician-led services at the same rural tertiary care center. METHODS: A retrospective cohort study of term, singleton, and vertex deliveries in patients without a history of cesarean delivery was performed. Patients self-selected a delivery service. The primary outcome was the odds of cesarean delivery between midwife and obstetrician-led services. After propensity score matching, logistic regression was performed on the matched sample to assess the adjusted odds of cesarean delivery. RESULTS: From January 2015 to December 2017, 1,787 (80.2% of total) deliveries were analyzed with management of 956 (53.5%) by the midwife service and 831 (46.5%) by the obstetrician-led service. The rate of cesarean delivery was 20.7% (n=172) in the obstetrician-led service and 13.1% (n=125) in the midwife service. In the matched sample, the odds of cesarean delivery were lower in the midwife service compared with the obstetrician-led service in unadjusted and adjusted analyses (odds ratio [OR] 0.62, 95% CI 0.47-0.81; adjusted odds ratio [aOR] 0.58, 95% CI 0.44-0.80). Older maternal age (OR 1.02, 95% CI 1.00-1.06; aOR 1.07, 95% CI 1.04-1.10) and higher delivery body mass index (OR 1.06, 95% CI 1.04-1.08; aOR 1.07, 95% CI 1.04-1.09) were associated with higher odds of cesarean delivery. Increased parity was associated with decreased odds of cesarean delivery (OR 0.41, 95% CI 0.31-0.55; aOR 0.35, 95% CI 0.26-0.48). There were no differences in neonatal outcomes. CONCLUSION: At a single rural tertiary care center, patients on the midwife service have significantly lower adjusted odds of cesarean delivery than patients on the obstetrician-led service.


Assuntos
Cesárea/estatística & dados numéricos , Tocologia/estatística & dados numéricos , Obstetrícia/estatística & dados numéricos , Adulto , Índice de Apgar , Feminino , Parto Domiciliar/estatística & dados numéricos , Humanos , Recém-Nascido , Modelos Logísticos , New Hampshire , Paridade , Gravidez , Resultado da Gravidez , Pontuação de Propensão , Estudos Retrospectivos , Adulto Jovem
6.
BMC Health Serv Res ; 20(1): 266, 2020 Mar 31.
Artigo em Inglês | MEDLINE | ID: mdl-32234043

RESUMO

BACKGROUND: In spite of the promotion of institutional delivery in Ethiopia, home delivery is still common primarily in hard-to-reach areas. Institutional delivery supported to achieve the goal of reducing maternal and neonatal mortality in Ethiopia. The objective of this study is to assess the determinants of institutional delivery in Ethiopia. METHODS: Cross sectional survey was conducted in 11 administrative regions of Ethiopia. The Ethiopian demographic and health survey data collection took place from January 18, 2016, to June 27, 2016. The study subjects were 11,023 women (15-49 years old) who gave birth in the preceding 5 years before 2016 Ethiopian demographic health survey. This representative data was downloaded from Demographic Health Survey after getting permission. The Primary outcome variable was institutional delivery. The data was transferred and analyzed with SPSS Version 20 statistical software package. RESULTS: Of 11,023 mothers, 2892 (26.2%) delivered at a health facility and 8131 (73.8%) at home. Women with secondary education were 4.36 times more likely to have an institutional delivery (OR: 4.36; 95% CI: 3.12-6.09). Institutional delivery was higher among women who were resided in urban areas by three fold (OR: 3.26; 95% CI: 2.19-4.35). Women who visited ANC (Antenatal care) were about two times more likely to choose institutional delivery (OR: 1.81; 95% CI: 1.58-2.07). Respondents who watch television at least once a week was two times more likely to experience institutional delivery than those who did not watch at all (0R: 1.90; 95% CI: 1.35-2.66). The wealthiest women were 2.61 times more likely to deliver in an institution compared with the women in the poorest category (OR: 2.61; 95% CI: 1.95-3.50). CONCLUSION: Women having higher educational level, being richest, residing in urban area, visiting antenatal care at least once, and frequent exposure to mass media were factors associated with institutional delivery. Improving access to education and health promotion about obstetrics and delivery through mass media will increase the uptake of institutional delivery.


Assuntos
Parto Obstétrico/estatística & dados numéricos , Instalações de Saúde/estatística & dados numéricos , Mães/estatística & dados numéricos , Adolescente , Adulto , Estudos Transversais , Etiópia , Feminino , Pesquisas sobre Serviços de Saúde , Parto Domiciliar/estatística & dados numéricos , Humanos , Meios de Comunicação de Massa/estatística & dados numéricos , Pessoa de Meia-Idade , Gravidez , Cuidado Pré-Natal/estatística & dados numéricos , Fatores Socioeconômicos , Adulto Jovem
7.
BMC Health Serv Res ; 20(1): 265, 2020 Mar 30.
Artigo em Inglês | MEDLINE | ID: mdl-32228558

RESUMO

BACKGROUND: Institutional delivery is a delivery that takes place at any medical facility staffed by skilled delivery assistance. It is estimated that using institutional delivery could reduce 16 to 33% of maternal deaths. Despite the importance of delivering at health institutions, in Ethiopia, mothers prefer to give birth at home. Therefore, the aim of this study was to compare institutional delivery service utilization and associated factors among rural and urban mothers in Mana district, Jimma Zone, Southwest Ethiopia, 2017. METHODS: A community based comparative cross sectional study was conducted in Mana district, Southwest Ethiopia from March to June, 2017. A stratified probability sampling technique was used to select a total of 1426 (713 urban, 713 rural) study participants. Data were collected from mothers who gave birth in the past 24 months by using a structured and pretested questionnaire. RESULTS: The overall prevalence of institutional delivery service utilization was 86.4%. Higher number of antenatal care visits, having good knowledge on the danger signs of labor, increased wealth index, primary and above educational level of the husband, mothers age below 40-year, and less than 30-min travel time to the nearby health institutions had significantly increased the rate of institutional delivery service utilization. CONCLUSION: Institutional delivery service utilization is high in the study area. Maternal awareness of danger signs of labor, frequent ANC visit and better education of husband, and household wealth predicted the utilization of the service. Therefore, due attention need to be given to enhancing education, expanding health institutions and creating awareness on advantage of antenatal care follow up and danger signs to make all pregnancies delivered at health institutions.


Assuntos
Parto Obstétrico , Utilização de Instalações e Serviços , Mães , Aceitação pelo Paciente de Cuidados de Saúde , Adolescente , Adulto , Estudos Transversais , Tomada de Decisões , Parto Obstétrico/estatística & dados numéricos , Etiópia , Utilização de Instalações e Serviços/estatística & dados numéricos , Feminino , Parto Domiciliar/estatística & dados numéricos , Humanos , Morte Materna , Pessoa de Meia-Idade , Mães/estatística & dados numéricos , Gravidez , Inquéritos e Questionários , Adulto Jovem
8.
Ciênc. Saúde Colet ; 25(4): 1433-1444, abr. 2020. tab
Artigo em Português | LILACS | ID: biblio-1089505

RESUMO

Resumo O parto domiciliar planejado (PDP) tem crescido cada vez mais no Brasil, especialmente nos grandes centros urbanos, frente à crescente insatisfação das mulheres com o sistema obstétrico hospitalar vigente. Estudos internacionais demonstram a segurança do PDP, porém a produção nacional ainda é limitada nesta área. Desta maneira, este estudo objetivou revisar a produção bibliográfica nacional acerca de parto domiciliar entre os anos de 2008 e 2018, a fim de compilar dados relacionados ao PDP no Brasil. Após levantamento, 18 estudos foram incluídos na revisão, sendo subdivididos nas seguintes categorias: "Desfechos maternos e neonatais dos PDP", "Sentimentos, motivação e perfis associados à escolha pelo PDP", "Percepção dos profissionais que atendem PDP" e "Abordagem teórica do PDP". Concluiu-se que o PDP tem crescido entre parcelas privilegiadas da população, representando importante prática de exercício da autonomia da mulher em contraponto ao modelo obstétrico vigente, apresentando-se como alternativa segura de local de parto, com alto grau de satisfação para as mulheres e famílias. Este modelo de assistência, entretanto, apresenta-se como opção limitada, uma vez que o PDP não é oferecido pelo Sistema Único de Saúde, ainda inacessível para a maioria das mulheres no país.


Abstract Planned home birth (PHB) has grown in Brazil, especially in large urban centers, in the face of women's dissatisfaction with the current obstetric system. International studies have demonstrated the security of PHB, but national production about this area is still limited. Thus, this study aimed to review the national bibliographic production about PHB between 2008 and 2018, in order to compile data related to PHB in Brazil. After survey, 18 studies were included in the review, and then subdivided into the following categories: "Maternal and neonatal outcomes of PHB", "Feelings, motivation and personal characteristics of women that choose PHB", "Perception of professionals that practice PHB" and "Theoretical approach to PHB". It was concluded that the PHB has grown between privileged portions of Brazilian population, representing the important practice of women's autonomy, presenting itself as a safe alternative place of birth, with a high degree of satisfaction of women and families. However, this model of assistance presents itself as a limited option, since the PHB is not offered by the Health System, still unaccessible to most of women in the country.


Assuntos
Humanos , Feminino , Gravidez , Recém-Nascido , Bibliometria , Parto Domiciliar/estatística & dados numéricos , Paridade , Fatores Socioeconômicos , Brasil , Resultado da Gravidez , Atitude do Pessoal de Saúde , Conhecimentos, Atitudes e Prática em Saúde , Transferência de Pacientes/estatística & dados numéricos , Satisfação do Paciente , Autonomia Pessoal , Episiotomia/estatística & dados numéricos , Preferência do Paciente/estatística & dados numéricos , Parto Domiciliar/psicologia , Motivação
9.
PLoS One ; 15(3): e0230341, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32163492

RESUMO

BACKGROUND: Maternal mortality remains a major challenge to health systems in low and middle-incoming countries. Some pregnant women develop potentially life-threatening complications during childbirth. Therefore, home delivery is a precursor for maternal mortality. In this study, we aimed at not only estimating the percentage of deliveries occurring at home and examining the factors associated with home delivery, but we also explored the reasons for home delivery among women in rural Ghana. METHODS: The study was conducted among mothers with delivery experience in selected communities in the Builsa South district located in the Upper East Region of Ghana. Both quantitative and qualitative data were collected using semi-structured questionnaires and Focus Group Discussion (FGD) guide respectively. A total of 456 mothers participated in this study. Regression models were used in the quantitative analysis whereas a thematic analysis approach was used to analyze the qualitative data. RESULTS: Of the 423 mothers in the quantitative research, 38.1% (95% CI: 33.5-42.8) delivered their index child at home. In adjusted analysis, women who were not exposed to information (AOR = 13.64, p<0.001) and women with 2 (AOR = 4.64, p = 0.014), 3 (AOR = 4.96, p = 0.025) or at least 4 living children (AOR = 9.59, p = 0.001) had higher odds of delivering at home. From the qualitative analysis, the poor attitude of nurses (midwives), lack of, and cost of transportation, cost of delivery kits, and traditional beliefs and practices were cited as reasons for home delivery. CONCLUSION: Despite the government's efforts to provide free maternal care services to women in Ghana, a significant proportion of rural women still deliver at home due to other 'hidden costs'. Addressing poor staff attitude, transportation challenges, and negative traditional beliefs and practices through awareness creation may contribute to improving health facility delivery by rural pregnant women in Ghana.


Assuntos
Parto Obstétrico/estatística & dados numéricos , Parto Domiciliar/estatística & dados numéricos , Serviços de Saúde Materna/estatística & dados numéricos , Pobreza/estatística & dados numéricos , Estudos Transversais , Feminino , Grupos Focais , Gana , Instalações de Saúde/estatística & dados numéricos , Humanos , Tocologia/estatística & dados numéricos , Mães , Gravidez , Gestantes , Cuidado Pré-Natal/estatística & dados numéricos , População Rural/estatística & dados numéricos , Inquéritos e Questionários
10.
PLoS One ; 15(3): e0229488, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32134957

RESUMO

BACKGROUND: Variations in childbirth interventions may indicate inappropriate use. Most variation studies are limited by the lack of adjustments for maternal characteristics and do not investigate variations in adverse outcomes. This study aims to explore regional variations in the Netherlands and their correlations with referral rates, birthplace, interventions, and adverse outcomes, adjusted for maternal characteristics. METHODS: In this nationwide retrospective cohort study, using a national data register, intervention rates were analysed between twelve regions among single childbirths after 37 weeks' gestation in 2010-2013 (n = 614,730). These were adjusted for maternal characteristics using multivariable logistic regression. Primary outcomes were intrapartum referral, birthplace, and interventions used in midwife- and obstetrician-led care. Correlations both between primary outcomes and between adverse outcomes were calculated with Spearman's rank correlations. FINDINGS: Intrapartum referral rates varied between 55-68% (nulliparous) and 20-32% (multiparous women), with a negative correlation with receiving midwife-led care at the onset of labour in two-thirds of the regions. Regions with higher referral rates had higher rates of severe postpartum haemorrhages. Rates of home birth varied between 6-16% (nulliparous) and 16-31% (multiparous), and was negatively correlated with episiotomy and postpartum oxytocin rates. Among midwife-led births, episiotomy rates varied between 14-42% (nulliparous) and 3-13% (multiparous) and in obstetrician-led births from 46-67% and 14-28% respectively. Rates of postpartum oxytocin varied between 59-88% (nulliparous) and 50-85% (multiparous) and artificial rupture of membranes between 43-52% and 54-61% respectively. A north-south gradient was visible with regard to birthplace, episiotomy, and oxytocin. CONCLUSIONS: Our study suggests that attitudes towards interventions vary, independent of maternal characteristics. Care providers and policy makers need to be aware of reducing unwarranted variation in birthplace, episiotomy and the postpartum use of oxytocin. Further research is needed to identify explanations and explore ways to reduce unwarranted intervention rates.


Assuntos
Parto Obstétrico/estatística & dados numéricos , Pessoal de Saúde/estatística & dados numéricos , Parto Domiciliar/estatística & dados numéricos , Serviços de Saúde Materna/estatística & dados numéricos , Tocologia/estatística & dados numéricos , Parto , Complicações na Gravidez , Feminino , Geografia , Humanos , Gravidez , Resultado da Gravidez , Estudos Retrospectivos
11.
BMC Pregnancy Childbirth ; 20(1): 97, 2020 Feb 11.
Artigo em Inglês | MEDLINE | ID: mdl-32046677

RESUMO

BACKGROUND: All pregnancies are at risk and have to be attended by skilled professionals. In Ethiopia however nearly half (45.7%) of the women were giving birth at home after antenatal care (ANC) visits in which skilled professionals were not available. Therefore, the aim of this study was to assess spatial clustering and the determinant factors of home delivery after antenatal care visits in Ethiopia. METHODS: A case control study was conducted on 2110 mothers who gave birth at home after ANC (cases), and 2510 mothers who gave birth at health institutions after attending ANC (controls), based on EDHS 2016 data. As per the recommendations of the DHS program, we weighed the data before analysis. ArcGIS 10.3 was used to show spatial pattern and SaTScan™ 9.4 to identify significant clusters. Stata 14 was used for data cleaning, weighing, and the analysis of the determinant factors. Bi variable and multi variable multilevel mixed effect logistic regression was fitted. Finally, the Log-likelihood ratio (LLR) and Relative risk with p-value of spatial scan statistics and AOR with 95% CI for significant determinant factors were reported. RESULTS: Home delivery after ANC was spatially clustered in Ethiopia (Moran's Index = 0.91, p-value< 0.01). Attending, 1-3 ANC visits (AOR = 1.41, 95%CI: 1.17-1.71), no information about birth preparedness plan (AOR = 2.21, 95%CI: 1.83-2.69), pregnancies wanted later (AOR = 1.55, 95%CI: 1.20, 2.06), not having health insurance (AOR = 2.16, 95% CI: 1.29, 3.62), Muslim (AOR = 1.57, 95% CI: 1.13, 2.19) and protestant (AOR = 1.72, 95%CI: 1.16, 2.42) religions were positively associated with home delivery; While being rich (AOR = 0.42, 95%CI: 0.32-0.54), middle wealth index (AOR = O.66, 95%CI: 0.51, 0.86), primary education (AOR = 0.45, 95%CI: 0.36-0.55), secondary education (AOR = 0.11, 95%CI: 0.07-0.16), above secondary education (AOR = 0.06, 95%CI: 0.03-0.11) were negatively associated. CONCLUSIONS: Home delivery after ANC follow ups was spatially clustered. Socio-demographic, health service and pregnancy related factors determined the prevalence of home delivery after antenatal care visits. Strengthening women's education, ANC visit, giving more information about birth preparedness plan, and improving family wealth are vital to reduce home delivery after antenatal care visits.


Assuntos
Parto Domiciliar/estatística & dados numéricos , Mães/estatística & dados numéricos , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Cuidado Pré-Natal/estatística & dados numéricos , Adolescente , Adulto , Ordem de Nascimento , Estudos de Casos e Controles , Análise por Conglomerados , Estudos Transversais , Demografia , Escolaridade , Etiópia , Feminino , Humanos , Renda , Gravidez , Análise Espacial , Adulto Jovem
12.
Am J Obstet Gynecol ; 223(2): 254.e1-254.e8, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32044310

RESUMO

BACKGROUND: Planned home births have leveled off in the United States in recent years after a significant rise starting in the mid-2000s. Planned home births in the United States are associated with increased patient-risk profiles. Multiple studies concluded that, compared with hospital births, absolute and relative risks of perinatal mortality and morbidity in US planned home births are significantly increased. OBJECTIVE: To explore the safety of birth in the United States by comparing the neonatal mortality outcomes of 2 locations, hospital birth and home birth, by 4 types of attendants: hospital midwife; certified nurse-midwife at home; direct-entry ("other") midwife at home; and attendant at home not identified, using the most recent US Centers for Disease Control and Prevention natality data on neonatal mortality for planned home births in the United States. Outcomes are presented as absolute risks (neonatal mortality per 10,000 live births) and as relative risks of neonatal mortality (hospital-certified nurse-midwife odds ratio, 1) overall, and for recognized risk factors. STUDY DESIGN: We used the most current US Centers for Disease and Prevention Control Linked Birth and Infant Death Records for 2010-2017 to assess neonatal mortality (neonatal death days 0-27 after birth) for single, term (37+ weeks), normal-weight ( >2499 g) infants for planned home births and hospital births by birth attendants: hospital-certified nurse-midwives, home-certified nurse-midwives, home other midwives (eg, lay or direct-entry midwives), and other home birth attendant not identified. RESULTS: The neonatal mortality for US hospital midwife-attended births was 3.27 per 10,000 live births, 13.66 per 10,000 live births for all planned home births, and 27.98 per 10,000 live births for unintended/unplanned home births. Planned home births attended by direct-entry midwives and by certified nurse-midwives had a significantly elevated absolute and relative neonatal mortality risk compared with certified nurse-midwife-attended hospital births (hospital-certified nurse-midwife: 3.27/10,000 live births odds ratio, 1; home birth direct-entry midwives: neonatal mortality 12.44/10,000 live births, odds ratio, 3.81, 95% confidence interval, 3.12-4.65, P<.0001; home birth-certified nurse-midwife: neonatal mortality 9.48/10,000 live births, odds ratio, 2.90, 95% confidence interval, 2.90; P<.0001). These differences increased further when patients were stratified for recognized risk factors. CONCLUSION: The safety of birth in the United States varies by location and attendant. Compared with US hospital births attended by a certified nurse-midwife, planned US home births for all types of attendants are a less safe setting of birth, especially when recognized risk factors are taken into account. The type of midwife attending US planned home birth appears to have no differential effect on decreasing the absolute and relative risk of neonatal mortality of planned home birth, because the difference in outcomes of US planned home births attended by direct-entry midwives or by certified nurse-midwives is not statistically significant.


Assuntos
Parto Domiciliar/estatística & dados numéricos , Mortalidade Infantil , Tocologia/estatística & dados numéricos , Enfermeiras Obstétricas/estatística & dados numéricos , Adulto , Entorno do Parto/estatística & dados numéricos , Feminino , Humanos , Lactente , Recém-Nascido , Intenção , Gravidez , Estados Unidos
13.
PLoS One ; 15(1): e0228440, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31999784

RESUMO

INTRODUCTION: In Nepal, a substantial proportion of women still deliver their child at home. Disparities have been observed in utilisation of institutional delivery and skilled birth attendant services. We performed a disaggregated analysis among marginalised and non-marginalised women to identify if different factors are associated with home delivery among these groups. MATERIALS AND METHODS: This study used data from the 2016 Nepal Demographic and Health Survey. It involves the analysis of 3,837 women who had experienced at least one live birth in the five years preceding the survey. Women were categorised as marginalised and non-marginalised based on ethnic group. Bivariate and multivariable logistic regression analysis were performed to identify factors associated with home delivery. RESULTS: A higher proportion of marginalised women delivered at home (47%) than non-marginalised women (26%). Compared to non-marginalised women (35%), a larger proportion of marginalised women (64%) felt that it was not necessary to give birth at health facility. The multivariable analysis indicated an independent association of having no or basic education, belonging to middle, poorer and the poorest wealth quintile, residing in Province 2 and not having completed of four antenatal care visits per protocol with home delivery among both marginalised and non-marginalised women. Whereas residing in a rural area, residing in Province 7, and at a distance of >30 minutes to a health facility were factors independently associated with home delivery only among marginalised women. CONCLUSION: We conclude that poor education, poor economic status, non-completion of four ANC visits and belonging to Province 2 particularly determined either group of women to deliver at home, whereas residing in rural areas, living far from health facility, and belonging to Province 7 determined marginalised women to deliver at home. Preventing mothers from delivering at home would thus require focusing on specific geographical areas besides considering wider socio-economic determinants.


Assuntos
Parto Domiciliar/psicologia , Cuidado Pré-Natal/estatística & dados numéricos , Marginalização Social/psicologia , Adolescente , Adulto , Parto Obstétrico/psicologia , Parto Obstétrico/estatística & dados numéricos , Feminino , Inquéritos Epidemiológicos , Disparidades em Assistência à Saúde/etnologia , Parto Domiciliar/estatística & dados numéricos , Humanos , Idade Materna , Serviços de Saúde Materna , Pessoa de Meia-Idade , Análise Multivariada , Nepal/epidemiologia , Gravidez , Cuidado Pré-Natal/psicologia , Fatores Socioeconômicos , Adulto Jovem
14.
Reprod Health ; 17(1): 3, 2020 Jan 13.
Artigo em Inglês | MEDLINE | ID: mdl-31931824

RESUMO

BACKGROUND: Pakistan reports the highest stillbirth rate in the world at 43 per thousand births with more than three-quarters occurring in rural areas. The Global Network for Women's and Children's Health maintains a Maternal and Newborn Health Registry (MNHR) in 14 study clusters of district Thatta, Sindh Pakistan. For the last 10 years, the MNHR has recorded a high stillbirths rate with a slow decline. This exploratory study was designed to understand the perspectives of women and traditional birth attendants regarding the high occurrence of stillbirth in Thatta district. METHODS: We used an exploratory qualitative study design by conducting in-depth interviews (IDIs) and focus group discussions (FGDs) using semi-structured interview guide with rural women (FGDs = 4; n = 29) and traditional birth attendants (FGDs = 4; n = 14) who were permanent residents of Thatta. In addition, in-depth interviews were conducted with women who had experienced a stillbirth (IDIs = 4). This study presents perceptions and experiences of women and TBAs regarding high rate of stillbirth in Thatta district, Karachi. RESULTS: Women showed reluctance to receive skilled/ standard care when in need due to apprehensions towards operative delivery, poor attitude of skilled health care providers, and poor quality of care as service delivery factors. High cost of care, far distance to facility, lack of transport and need of an escort from the family or village to visit a health facility were additional important factors for not seeking care resulting in stillbirth. The easy availability of unskilled provider in the form of traditional birth attendant is then preferred over a skilled health care provider. TBAs shared their husband or family members restrict them to visit or consult a doctor during pregnancy. According to TBAs after delivering a macerated fetus, women are given herbs to remove infection from woman's body and uterus. Further women are advised to conceive soon so that they get rid of infections. CONCLUSION: Women of this rural community carry lots of apprehension against skilled medical care and as a result follow traditional practices. Conscious efforts are required to increase the awareness of women to develop positive health seeking behavior during pregnancy, delivery and the post-partum period. Alongside, provision of respectful maternity care needs to be emphasized especially at public health facilities.


Assuntos
Parto Domiciliar/psicologia , Parto Domiciliar/estatística & dados numéricos , Serviços de Saúde Materna/estatística & dados numéricos , Tocologia/estatística & dados numéricos , Aceitação pelo Paciente de Cuidados de Saúde , Natimorto/epidemiologia , Adulto , Tomada de Decisões , Feminino , Humanos , Recém-Nascido , Pessoa de Meia-Idade , Paquistão/epidemiologia , Gravidez , Pesquisa Qualitativa , População Rural , Natimorto/psicologia , Adulto Jovem
15.
Women Birth ; 33(5): e420-e428, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31668870

RESUMO

BACKGROUND: Home births provide women a birth choice where they may feel more comfortable and confident in their ability to give birth. PROBLEM: Most women in Victoria do not have publicly funded access to appropriately trained health professionals if they choose to give birth at home. METHODS: This paper describes the process of setting up a publicly funded home birth service and provide details of description of the set up and governance. We also report outcomes over 9 years with respect to parity, transfer to hospital, adverse maternal and neonatal outcomes. RESULTS: Of the 191 women who were still booked into the home birth program at 36 weeks gestation, 148 (77.5%) women gave birth at home and 43 (22.5%) women were transferred into the hospital. The overall rate of vaginal birth was also high among the women in the home birth program, 185 (96.9%) with no added complications ascribed to home births. Such as severe perineal trauma [n=1] 0.6% PPH [n=4] 2.7%, Apgar score less than 7 at 5min [n=0] admissions post home birth to special care nursery [n=2] 1.35%. DISCUSSION: This unique study provides a detailed road map of setting up a home birth practice to facilitate other institutions keen to build a publicly funded home birth service. The birth outcome data was found to be consistent with other Australian studies on low risk home births. CONCLUSION: Well-designed home birth programs following best clinical practices and procedures can provide a safe birthing option for low risk women.


Assuntos
Parto Obstétrico/economia , Parto Domiciliar/economia , Serviços de Saúde Materna/economia , Tocologia/economia , Adulto , Austrália , Feminino , Parto Domiciliar/estatística & dados numéricos , Humanos , Recém-Nascido , Modelos de Enfermagem , Paridade , Gravidez , Desenvolvimento de Programas , Avaliação de Programas e Projetos de Saúde
16.
Acta Obstet Gynecol Scand ; 99(4): 546-554, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-31713236

RESUMO

INTRODUCTION: Midwife-led models of care have been the subject of debate for many years. We conducted a study to compare intrapartum and neonatal mortality rates in midwife-led (primary) vs obstetrician-led (secondary) care at the onset of labor in low-risk term women. MATERIAL AND METHODS: We performed an unmatched and a propensity score matched cohort study using data from the national perinatal audit registry (PAN) and from the national perinatal registry (PERINED) of the Netherlands. We included women with singleton pregnancies (without congenital anomalies or antepartum fetal death) who gave birth at term between 2010 and 2012. We excluded the following major risk factors: non-vertex position of the fetus, previous cesarean birth, hypertension, diabetes mellitus, prolonged rupture of membranes (≥24 hours), vaginal bleeding in the second half of pregnancy, nonspontaneous start of labor and post-term pregnancy (≥42 weeks). The primary outcome was intrapartum or neonatal mortality up to 28 days after birth. Secondary outcome measures were mode of delivery and a 5-minute Apgar score <7. RESULTS: We included 259 211 women. There were 100/206 642 (0.48‰) intrapartum and neonatal deaths in the midwife group and 23/52 569 (0.44‰) in the obstetrician group (odds ratio [OR] 1.11, 95% CI 0.70-1.74). Propensity score matched analysis showed mortality rates of 0.49‰ (26/52 569) among women in midwife-led care and 0.44‰ (23/52 569) for women in obstetrician-led care (OR 1.13, 95% CI 0.65-1.98). In the midwife group there were significantly lower rates of vaginal instrumental deliveries (8.4% vs 13.0%; matched OR 0.65, 95% CI 0.62-0.67) and intrapartum cesarean sections (2.6% vs 8.2%; matched OR 0.32, 95% CI 0.30-0.34), and fewer neonates with low Apgar scores (<7 after 5 minutes) (0.69% vs 1.11%; matched OR 0.61, 95% CI 0.53-0.69). CONCLUSIONS: Among low-risk term women, there were comparable intrapartum and neonatal mortality rates for women starting labor in midwife-led vs obstetrician-led care, with lower intervention rates and fewer low Apgar scores in the midwife group.


Assuntos
Tocologia/estatística & dados numéricos , Obstetrícia/estatística & dados numéricos , Mortalidade Perinatal , Adulto , Índice de Apgar , Cesárea/estatística & dados numéricos , Estudos de Coortes , Extração Obstétrica/estatística & dados numéricos , Feminino , Parto Domiciliar/estatística & dados numéricos , Hospitais/estatística & dados numéricos , Humanos , Recém-Nascido , Início do Trabalho de Parto , Países Baixos/epidemiologia , Paridade , Parto , Gravidez , Pontuação de Propensão , Sistema de Registros , Fatores de Risco , Adulto Jovem
17.
Women Birth ; 33(5): e464-e472, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31699461

RESUMO

BACKGROUND: In Ethiopia, it is encouraged that labour and delivery care are performed under the observation of skilled/trained midwifery or medical professionals. However, 70% of all births occur outside the healthcare system under the care of unskilled birth attendants, family members, or without any assistance at all. OBJECTIVE: This study aimed to assess the reasons for choosing homebirth and the role of traditional birth attendants in Arba Minch Health and Demographic Surveillance Site. METHOD: A qualitative, exploratory study was carried out between May and June 2017. Twenty-nine semi-structured interviews were conducted with various respondent groups such as traditional birth attendants, pregnant women, skilled birth attendants, and health extension workers. Data were transcribed and for analysis, structured as per the participants' responses, sorted and categorized as per the topic guide, and presented in narrative form. FINDINGS: The study revealed that traditional birth attendants are actively engaged in assisting homebirths in the selected area. It was also found that many women still prefer traditional birth attendants for childbirth assistance. Reasons for choosing homebirth included lack of transport to health care facilities, distance to health care facilities, lack of respectful care at health care facilities, and the friendliness of traditional birth attendants. Lack of formal partnerships between traditional birth attendants and the health system was also observed. CONCLUSIONS: There is a need to incorporate traditional birth attendants as a link between healthcare facilities and pregnant women; thereby, improving respectful care at the healthcare facilities.


Assuntos
Tomada de Decisões , Parto Domiciliar/estatística & dados numéricos , Serviços de Saúde Materna/estatística & dados numéricos , Tocologia , Preferência do Paciente , Adulto , Parto Obstétrico , Etiópia , Feminino , Acesso aos Serviços de Saúde , Humanos , Entrevistas como Assunto , Gravidez , Pesquisa Qualitativa
18.
Women Birth ; 33(3): 286-293, 2020 May.
Artigo em Inglês | MEDLINE | ID: mdl-31227444

RESUMO

BACKGROUND: Women want greater choice of place of birth in New South Wales, Australia. It is perceived to be more costly to health services for women with a healthy pregnancy to give birth at home or in a birth centre. It is not known how much it costs the health service to provide care for women planning to give birth in these settings. AIM: The aim of this study was to determine the direct cost of giving birth vaginally at home, in a birth centre or in a hospital for women at low risk of complications, in New South Wales. METHODS: A micro-costing design was used. Observational (time and motion) and resource use data collection was undertaken to identify the staff time and resources required to provide care in a public hospital, birth centre or at home for women with a healthy pregnancy. FINDINGS: The median cost of providing care for women who plan to give birth at home, in a birth centre and in a hospital were similar (AUD $2150.07, $2100.59 and $2097.30 respectively). Midwifery time was the largest contributor to the cost of birth at home, and overhead costs accounted for over half of the total cost of BC and hospital birth. The cost of consumables was low in all three settings. CONCLUSION: In this study, we have found there is little difference in the cost to the health service when a woman has an uncomplicated vaginal birth at home, in a birth centre or in a hospital setting.


Assuntos
Centros de Assistência à Gravidez e ao Parto/estatística & dados numéricos , Parto Domiciliar/estatística & dados numéricos , Tocologia/estatística & dados numéricos , Coleta de Dados , Feminino , Hospitais/estatística & dados numéricos , Humanos , New South Wales , Parto , Gravidez
19.
BMC Pregnancy Childbirth ; 19(1): 513, 2019 Dec 21.
Artigo em Inglês | MEDLINE | ID: mdl-31864317

RESUMO

BACKGROUND: In New South Wales (NSW) Australia, women at low risk of complications can choose from three birth settings: home, birth centre and hospital. Between 2000 and 2012, around 6.4% of pregnant women planned to give birth in a birth centre (6%) or at home (0.4%) and 93.6% of women planned to birth in a hospital. A proportion of the woman in the home and birth centre groups transferred to hospital. However, their pathways or trajectories are largely unknown. AIM: The aim was to map the trajectories and interventions experienced by women and their babies from births planned at home, in a birth centre or in a hospital over a 13-year period in NSW. METHODS: Using population-based linked datasets from NSW, women at low risk of complications, with singleton pregnancies, gestation 37-41 completed weeks and spontaneous onset of labour were included. We used a decision tree framework to depict the trajectories of these women and estimate the probabilities of the following: giving birth in their planned setting; being transferred; requiring interventions and neonatal admission to higher level hospital care. The trajectories were analysed by parity. RESULTS: Over a 13-year period, 23% of nulliparous and 0.8% of multiparous women planning a home birth were transferred to hospital. In the birth centre group, 34% of nulliparae and 12% of multiparas were transferred to a hospital. Normal vaginal birth rates were higher in multiparous women compared to nulliparous women in all settings. Neonatal admission to SCN/NICU was highest in the planned hospital group for nulliparous women (10.1%), 7.1% for nulliparous women planning a birth centre birth and 5.1% of nulliparous women planning a homebirth. Multiparas had lower admissions to SCN/NICU for all thee settings (hospital 6.3%, BC 3.6%, home 1.6%, respectively). CONCLUSIONS: Women who plan to give birth at home or in a birth centre have high rates of vaginal birth, even when transferred to hospital. Evidence on the trajectories of women who choose to give birth at home or in birth centres will assist the planning, costing and expansion of models of care in NSW.


Assuntos
Entorno do Parto/estatística & dados numéricos , Unidades de Terapia Intensiva Neonatal/estatística & dados numéricos , Intenção , Paridade , Transferência de Pacientes/estatística & dados numéricos , Adolescente , Adulto , Centros de Assistência à Gravidez e ao Parto , Cesárea/estatística & dados numéricos , Árvores de Decisões , Parto Obstétrico , Extração Obstétrica/estatística & dados numéricos , Feminino , Parto Domiciliar/estatística & dados numéricos , Humanos , Recém-Nascido , New South Wales , Gravidez , Estudos Retrospectivos , Adulto Jovem
20.
BMC Public Health ; 19(1): 1501, 2019 Nov 11.
Artigo em Inglês | MEDLINE | ID: mdl-31711460

RESUMO

BACKGROUND: Maternal morbidity and mortality continued to be major issues in many countries. Globally a total of 10.7 million women have died between 1990 and 2015 due to maternal causes where sub-Saharan Africa alone accounts for 66% of maternal death. Since most maternal deaths are avoidable; skilled attendance during pregnancy, childbirth, and the postpartum is among the most critical interventions for improving maternal and neonatal survival. The study aimed to assess the magnitude and associated factors of utilization of skilled birth attendant at birth among women who gave birth in the last 24 months preceding the study in Gura Dhamole Woreda, Bale Zone Southeast Ethiopia, 2017. METHODS: Community based cross-sectional study was implemented from March 25 to April 24, 2017 in Gura Dhamole Woreda on total of 402 study subjects who were selected by Multi-stage sampling technique. The data were collected using pre-tested structured questionnaire and data was coded, entered, cleaned and analyzed using Statistical Package for Social Service (SPSS) Version 20. Odds ratio with 95% Confidence Interval (CI) was used to assess associations the dependent and independent variables. Logistic regression model was employed to identify independent predictors and variables were declared statistically significant at P value < 0.05. RESULT: In this study only 29.2% of women were assisted by Skilled Birth Attendance (SBA) during their child birth. Place of residence, mother education, travel time, joint decision on the place of delivery, ANC visit frequency, birth preparedness and complication readiness status, knowledge on obstetric danger signs after delivery and knowledge of presence of maternity waiting homes were significantly associated with SBA utilization. CONCLUSION: Skilled birth attendant utilization in the study area was low. Strategies that improve attendance of antenatal care utilization and attention to birth preparedness and complication readiness and counseling on danger signs are recommended.


Assuntos
Parto Obstétrico/estatística & dados numéricos , Tocologia/estatística & dados numéricos , Cuidado Pré-Natal/estatística & dados numéricos , Adolescente , Adulto , Estudos Transversais , Etiópia , Feminino , Acesso aos Serviços de Saúde/estatística & dados numéricos , Parto Domiciliar/estatística & dados numéricos , Humanos , Mortalidade Materna , Mães/psicologia , Gravidez
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