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1.
Artigo em Inglês | MEDLINE | ID: mdl-34639661

RESUMO

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 The available cost figures for home births are largely out of date or anecdotal.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.


Assuntos
Centros de Assistência à Gravidez e ao Parto , Parto Domiciliar , Tocologia , Feminino , Humanos , Recém-Nascido , Gravidez , Risco , Estados Unidos
2.
Midwifery ; 103: 103101, 2021 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-34352599

RESUMO

OBJECTIVE: To explore women's representations of pregnancy and childbirth and how these representations are constructed and have changed. BACKGROUND: In the 1980s, many women in Quebec demanded that the birthing process be both demedicalised and humanised, resulting in the legalisation of the midwife profession while expanding their choices over birthing locations within the public health system (e.g., birthing centres, the home, or hospitals). Birth-related technologies were also improving at that time. Nearly 40 years later, we wanted to learn about their perceptions. METHOD: This qualitative and contextualised phenomenological study surveyed 25 first-time mothers who had received care from midwives, general practitioners, or obstetricians. Each participant met with the researcher twice during her pregnancy and once after giving birth to engage in narrative conversations, which were analysed from an interdisciplinary viewpoint (socio-anthropology). FINDINGS: Participant perceptions of pregnancy varied. Some saw it as a state that distorted the body, while others saw it as a long period of struggle with a compulsory step that was also fascinating and/or even happy. Women undergo an incremental process of change before contemplating childbirth, and typically undergo a transitional period when nearing the event itself. They may think of childbirth as joyful and/or painful. Representations are built intersubjectively through influences involving family, the media, and care providers. Stories from their mothers, therefore, created undeniable impressions. CONCLUSION: In a context heavily influenced by technology, easy pregnancies and/or childbirth events are typically deemed "lucky." This negatively reinforces both the cultural and intergenerational values transmitted regarding these events.


Assuntos
Centros de Assistência à Gravidez e ao Parto , Tocologia , Parto Obstétrico , Feminino , Humanos , Recém-Nascido , Estudos Longitudinais , Parto , Gravidez
3.
BMC Health Serv Res ; 21(1): 816, 2021 Aug 14.
Artigo em Inglês | MEDLINE | ID: mdl-34391422

RESUMO

BACKGROUND: In New South Wales (NSW), Australia there are three settings available for women at low risk of complications to give birth: home, birth centre and hospital. Between 2000 and 2012, 93.6% of babies were planned to be born in hospital, 6.0% in a birth centre and 0.4% at home. Availability of alternative birth settings is limited and the cost of providing birth at home or in a birth centre from the perspective of the health system is unknown. OBJECTIVES: The objective of this study was to model the cost of the trajectories of women who planned to give birth at home, in a birth centre or in a hospital from the public sector perspective. METHODS: This was a population-based study using linked datasets from NSW, Australia. Women included met the following selection criteria: 37-41 completed weeks of pregnancy, spontaneous onset of labour, and singleton pregnancy at low risk of complications. We used a decision tree framework to depict the trajectories of these women and Australian Refined-Diagnosis Related Groups (AR-DRGs) were applied to each trajectory to estimate the cost of birth. A scenario analysis was undertaken to model the cost for 30 000 women in one year. FINDINGS: 496 387 women were included in the dataset. Twelve potential outcome pathways were identified and each pathway was costed using AR-DRGs. An overall cost was also calculated by place of birth: $AUD4802 for homebirth, $AUD4979 for a birth centre birth and $AUD5463 for a hospital birth. CONCLUSION: The findings from this study provides some clarity into the financial saving of offering more options to women seeking an alternative to giving birth in hospital. Given the relatively lower rates of complex intervention and neonatal outcomes associated with women at low risk of complications, we can assume the cost of providing them with homebirth and birth centre options could be cost-effective.


Assuntos
Centros de Assistência à Gravidez e ao Parto , Parto Domiciliar , Austrália/epidemiologia , Entorno do Parto , Feminino , Humanos , Recém-Nascido , Parto , Gravidez
4.
Am Fam Physician ; 103(11): 672-679, 2021 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-34060788

RESUMO

Since the 1970s, most births in the United States have been planned to occur in a hospital. However, a small percentage of Americans choose to give birth outside of a hospital. The number of out-of-hospital births has increased, with one in every 61 U.S. births (1.64%) occurring out of the hospital in 2018. Out-of-hospital (or community) birth can be planned or unplanned. Of those that are planned, most occur at home and are assisted by midwives. Patients who choose a planned community birth do so for multiple reasons. International observational studies that demonstrate comparable outcomes between planned out-of-hospital and planned hospital birth may not be generalizable to the United States. Most U.S. studies have found statistically significant increases in perinatal mortality and neonatal morbidity for home birth compared with hospital birth. Conversely, planned community birth is associated with decreased odds of obstetric interventions, including cesarean delivery. Perinatal outcomes for community birth may be improved with appropriate selection of low-risk, vertex, singleton, term pregnancies in patients who have not had a previous cesarean delivery. A qualified, licensed maternal and newborn health professional who is integrated into a maternity health care system should attend all planned community births. Family physicians are uniquely poised to provide counseling to patients and their families about the risks and benefits associated with community birth, and they may be the first physicians to evaluate and treat newborns delivered outside of a hospital.


Assuntos
Entorno do Parto , Centros de Assistência à Gravidez e ao Parto , Parto Domiciliar , Entorno do Parto/tendências , Centros de Assistência à Gravidez e ao Parto/normas , Centros de Assistência à Gravidez e ao Parto/tendências , Feminino , Parto Domiciliar/efeitos adversos , Parto Domiciliar/métodos , Parto Domiciliar/tendências , Humanos , Recém-Nascido , Tocologia/normas , Tocologia/tendências , Participação do Paciente , Segurança do Paciente , Seleção de Pacientes , Assistência Perinatal/métodos , Assistência Perinatal/normas , Guias de Prática Clínica como Assunto , Gravidez , Medição de Risco , Estados Unidos
6.
WMJ ; 120(1): 45-50, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33974765

RESUMO

OBJECTIVE: The American College of Obstetrics and Gynecology (ACOG) has recommended every hospital disclose their level of maternal care (LOMC) to categorize the capabilities of their birthing center and regionalize perinatal care. Of the 98 birthing centers in Wisconsin, 44% have self-disclosed their LOMC. In many states, disclosing LOMC is mandated but, despite evidence and professional association recommendations, Wisconsin relies on voluntary self-reporting. We surveyed all birthing centers in Wisconsin to better understand the barriers to disclosing their LOMC. STUDY DESIGN: An anonymous survey was sent to all 98 birthing centers in Wisconsin. Survey recipients were hospital administrators, nursing supervisors, or physician directors of obstetric units. The survey sought information on perceived barriers to completing self-assessments and disclosing their hospital's LOMC. Quantitative descriptive statistics were used for data analysis. RESULTS: Of 98 birth centers in Wisconsin, 40 (40.8%) responded. Fifteen of the 40 responses were from birthing centers that have not yet disclosed their LOMC. Of these, 93% were unsure how to disclose, 73% found the paperwork confusing, and 80% did not have the time or staff to complete the paperwork. Respondents did not report lack of departmental support, concerns about losing business or reputation, or future physician recruitment as barriers. Of all respondents, 77.5% were aware of ACOG's LOMC recommendations, but only 35% thought disclosing their LOMC would be beneficial to maternal care. CONCLUSIONS: Birthing centers in Wisconsin need further guidance on how to complete a self-assessment of their LOMC. In order to increase self-disclosure of LOMC, statewide perinatal organizations will need to continue to emphasize the benefits of releasing this information. Organizations should also provide additional support to level 1 and 2 birthing centers and improve maternal and neonatal care overall.


Assuntos
Centros de Assistência à Gravidez e ao Parto , Serviços de Saúde Materna , Obstetrícia , Feminino , Hospitais , Humanos , Recém-Nascido , Gravidez , Estados Unidos , Wisconsin
7.
BMC Pregnancy Childbirth ; 21(1): 404, 2021 May 27.
Artigo em Inglês | MEDLINE | ID: mdl-34044791

RESUMO

BACKGROUND: Partographs should be used universally to monitor the mother and fetus's conditions during delivery. However, its application in different parts of the world, including Ethiopia, is inconsistent. Moreover, its magnitude has not been determined in study area. As a result, the aim of this study was to investigate the utilization of partograph and associated factors among obstetric caregivers in public health institutions of Southwest Ethiopian. METHODS: An institutional-based cross-sectional study was conducted in Southwest Ethiopia from March 1st to June 30th, 2018. A simple random sampling technique was used to select study participants. A self-administered questionnaire was used to gather data on background characteristics, knowledge of partograph, and partograph utilization. The collected data were entered into an EPI Info and analysed using SPSS Version 22. We used bivariate and multivariate logistic regression analysis. Frequencies, tables, and graphs were used to present the final results. To determine statistical significance, a P-value of less than 0.05 was used. RESULT: The response rate of this study was 393(92.2 %). The magnitude of utilization of partograph was 43 % with (95 % CI: 38.4, 48.1). According to the multivariate analysis being nurse or health officer [AOR = 0.37(0.21, 0.66)], degree level educational qualification [AOR = 0.32 (0.17, 0.60)], being trainined on partograph [Adjusted OR = 7.83 (95 % CI: (4.54, 13.50)], good knowledge about partograph [AOR = 5.84 (95 % CI: (3.27, 10.44)] and working at health center [AOR = 1.99 (95 % CI: (1.12, 3.52)] were found as determinants of partograph utilization. CONCLUSIONS: The magnitude of partograph utilization among obstetric caregivers was found to be low in this study. Partograph utilization was determined by the type of profession, qualification level, knowledge of partograph, in-service training, and type of institution. To ensure its regular, obstetric caregivers must receive training and gain knowledge about it.


Assuntos
Trabalho de Parto , Monitorização Fisiológica/estatística & dados numéricos , Complicações do Trabalho de Parto/prevenção & controle , Padrões de Prática Médica/estatística & dados numéricos , Cuidado Pré-Natal , Adulto , Centros de Assistência à Gravidez e ao Parto , Estudos Transversais , Etiópia , Feminino , Humanos , Masculino , Obstetrícia , Gravidez , Inquéritos e Questionários
8.
Ital J Pediatr ; 47(1): 94, 2021 Apr 19.
Artigo em Inglês | MEDLINE | ID: mdl-33874990

RESUMO

BACKGROUND: Genetic diseases are chronic conditions with relevant impact on the lives of patients and their families. In USA and Europe it is estimated a prevalence of 60 million affected subjects, 75% of whom are in developmental age. A significant number of newborns are admitted in the Neonatal Intensive Care Units (NICU) for reasons different from prematurity, although the prevalence of those with genetic diseases is unknown. It is, then, common for the neonatologist to start a diagnostic process on suspicion of a genetic disease or malformation syndrome, or to make and communicate these diagnoses. Many surveys showed that the degree of parental satisfaction with the methods of communication of diagnosis is low. Poor communication may have short and long-term negative effects on health and psychological and social development of the child and his family. We draw up recommendations on this issue, shared by 6 Italian Scientific Societies and 4 Parents' Associations, aimed at making the neonatologist's task easier at the difficult time of communication to parents of a genetic disease/malformation syndrome diagnosis for their child. METHODS: We used the method of the consensus paper. A multidisciplinary panel of experts was first established, based on the clinical and scientific sharing of the thematic area of present recommendations. They were suggested by the Boards of the six Scientific Societies that joined the initiative: Italian Societies of Pediatrics, Neonatology, Human Genetics, Perinatal Medicine, Obstetric and Gynecological Ultrasound and Biophysical Methodologies, and Pediatric Genetic Diseases and Congenital Disabilities. To obtain a deeper and global vision of the communication process, and to reach a better clinical management of patients and their families, representatives of four Parents' Associations were also recruited: Italian Association of Down People, Cornelia de Lange National Volunteer Association, Italian Federation of Rare Diseases, and Williams Syndrome People Association. They worked from September 2019 to November 2020 to achieve a consensus on the recommendations for the communication of a new diagnosis of genetic disease. RESULTS: The consensus of experts drafted a final document defining the recommendations, for the neonatologist and/or the pediatrician working in a fist level birthing center, on the first communication of genetic disease or malformation syndrome diagnosis. Although there is no universal communication technique to make the informative process effective, we tried to identify a few relevant strategic principles that the neonatologist/pediatrician may use in the relationship with the family. We also summarized basic principles and significant aspects relating to the modalities of interaction with families in a table, in order to create an easy tool for the neonatologist to be applied in the daily care practice. We finally obtained an intersociety document, now published on the websites of the Scientific Societies involved. CONCLUSIONS: The neonatologist/pediatrician is often the first to observe complex syndromic pictures, not always identified before birth, although today more frequently prenatally diagnosed. It is necessary for him to know the aspects of genetic diseases related to communication and bioethics, as well as the biological and clinical ones, which together outline the cornerstones of the multidisciplinary care of these patients. This consensus provide practical recommendations on how to make the first communication of a genetic disease /malformation syndrome diagnosis. The proposed goal is to make easier the informative process, and to implement the best practices in the relationship with the family. A better doctor-patient/family interaction may improve health outcomes of the child and his family, as well as reduce legal disputes with parents and the phenomenon of defensive medicine.


Assuntos
Centros de Assistência à Gravidez e ao Parto , Anormalidades Congênitas/diagnóstico , Aconselhamento Genético , Doenças Genéticas Inatas/diagnóstico , Neonatologistas , Pediatras , Diagnóstico Pré-Natal , Anormalidades Congênitas/psicologia , Anormalidades Congênitas/terapia , Consenso , Feminino , Doenças Genéticas Inatas/psicologia , Doenças Genéticas Inatas/terapia , Humanos , Unidades de Terapia Intensiva Neonatal , Itália , Pais/psicologia , Gravidez , Sociedades Científicas , Revelação da Verdade
9.
BMC Pregnancy Childbirth ; 21(1): 329, 2021 Apr 26.
Artigo em Inglês | MEDLINE | ID: mdl-33902472

RESUMO

BACKGROUND: Health facility deliveries are generally associated with improved maternal and child health outcomes. However, in Uganda, little is known about factors that influence use of health facilities for delivery especially in rural areas. In this study, we assessed the factors associated with health facility deliveries among mothers living within the catchment areas of major health facilities in Rukungiri and Kanungu districts, Uganda. METHODS: Cross-sectional data were collected from 894 randomly-sampled mothers within the catchment of two private hospitals in Rukungiri and Kanungu districts. Data were collected on the place of delivery for the most recent child, mothers' sociodemographic and economic characteristics, and health facility water, sanitation and hygiene (WASH) status. Modified Poisson regression was used to estimate prevalence ratios (PRs) for the determinants of health facility deliveries as well as factors associated with private versus public utilization of health facilities for childbirth. RESULTS: The majority of mothers (90.2%, 806/894) delivered in health facilities. Non-facility deliveries were attributed to faster progression of labour (77.3%, 68/88), lack of transport (31.8%, 28/88), and high cost of hospital delivery (12.5%, 11/88). Being a business-woman [APR = 1.06, 95% CI (1.01-1.11)] and belonging to the highest wealth quintile [APR = 1.09, 95% CI (1.02-1.17)] favoured facility delivery while a higher parity of 3-4 [APR = 0.93, 95% CI (0.88-0.99)] was inversely associated with health facility delivery as compared to parity of 1-2. Factors associated with delivery in a private facility compared to a public facility included availability of highly skilled health workers [APR = 1.15, 95% CI (1.05-1.26)], perceived higher quality of WASH services [APR = 1.11, 95% CI (1.04-1.17)], cost of the delivery [APR = 0.85, 95% CI (0.78-0.92)], and availability of caesarean services [APR = 1.13, 95% CI (1.08-1.19)]. CONCLUSION: Health facility delivery service utilization was high, and associated with engaging in business, belonging to wealthiest quintile and having higher parity. Factors associated with delivery in private facilities included health facility WASH status, cost of services, and availability of skilled workforce and caesarean services.


Assuntos
Entorno do Parto/estatística & dados numéricos , Centros de Assistência à Gravidez e ao Parto , Parto Obstétrico , Serviços de Saúde Materna/organização & administração , Instalações Privadas , Logradouros Públicos , Adulto , Centros de Assistência à Gravidez e ao Parto/economia , Centros de Assistência à Gravidez e ao Parto/normas , Estudos Transversais , Parto Obstétrico/economia , Parto Obstétrico/métodos , Parto Obstétrico/estatística & dados numéricos , Demografia , Feminino , Acesso aos Serviços de Saúde , Humanos , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Gravidez , Instalações Privadas/normas , Instalações Privadas/estatística & dados numéricos , Logradouros Públicos/normas , Logradouros Públicos/estatística & dados numéricos , Serviços de Saúde Rural/economia , Serviços de Saúde Rural/normas , Serviços de Saúde Rural/estatística & dados numéricos , Fatores Socioeconômicos , Uganda/epidemiologia
10.
Birth ; 48(2): 242-250, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-33677838

RESUMO

BACKGROUND: The COVID-19 pandemic introduced unparalleled uncertainty into the lives of pregnant women, including concerns about where it is the safest to give birth, while preserving their rights and wishes. Reports on the increased interest in community births (at home or in birth centers) are emerging. The purpose of this project was to quantitatively investigate psychological factors related to this birth preference. METHODS: This study included 3896 pregnant women from the COVID-19 Pregnancy Experiences (COPE) Study who were anticipating a vaginal birth. COPE Study participants were recruited online between April 24 and May 15, 2020, and completed a questionnaire that included preference with respect to place of birth and psychological constructs: fear of childbirth, basic beliefs about birth, pandemic-related preparedness stress, and pandemic-related perinatal infection stress. RESULTS: Women who preferred a community birth, on average, had less childbirth fear, had stronger beliefs that birth is a natural process, were less likely to see birth as a medical process, and were less stressed about being unprepared for birth and being infected with COVID-19. In multivariate models, higher stress about perinatal COVID-19 infection was associated with greater likelihood of preferring a community birth. The effect of perinatal infection stress on preference was stronger when preparedness stress was high. DISCUSSION: Women's birth preferences during the COVID-19 pandemic are associated with psychological processes related to risk perception. Community births are more appealing to women who view being in a hospital as hazardous because of the pandemic. Policies and prenatal care aimed to increase access to safe in-hospital and out-of-hospital birth services should be encouraged.


Assuntos
Centros de Assistência à Gravidez e ao Parto/estatística & dados numéricos , COVID-19 , Parto Domiciliar/estatística & dados numéricos , Parto/psicologia , Complicações na Gravidez , Estresse Psicológico , Adulto , COVID-19/epidemiologia , COVID-19/prevenção & controle , COVID-19/psicologia , Medo , Feminino , Humanos , Preferência do Paciente/psicologia , Preferência do Paciente/estatística & dados numéricos , Gravidez , Complicações na Gravidez/diagnóstico , Complicações na Gravidez/epidemiologia , Complicações na Gravidez/etiologia , Gestantes/psicologia , SARS-CoV-2 , Percepção Social , Estresse Psicológico/diagnóstico , Estresse Psicológico/epidemiologia , Estresse Psicológico/etiologia , Incerteza
12.
Enferm. clín. (Ed. impr.) ; 31(1): 21-30, ene.-feb. 2021. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-202287

RESUMO

OBJETIVO: Conocer el grado de satisfacción de las mujeres tras el parto en el Hospital Universitario Materno-Infantil de Gran Canaria (HUMIC) y establecer posibles relaciones entre el grado de satisfacción y las variables estudiadas. MÉTODO: Estudio observacional descriptivo de corte transversal con componente analítico. La población a estudio fueron las mujeres cuyo parto tuvo lugar en el mes de noviembre del 2018 en el HUMIC reclutadas mediante muestreo no probabilístico de tipo consecutivo. Se utilizó el cuestionario Childbirth Experience Questionnaire en su versión española (CEQ-E) (cuestionario con 4 dominios: capacidad propia, apoyo profesional, seguridad percibida y participación/modelo de análisis 2). En una primera fase se realizó un análisis descriptivo y en una segunda, un análisis inferencial para explorar la asociación entre diferentes variables. RESULTADOS: La muestra total fue de 257 mujeres (n=257). La puntuación total con el CEQ-E fue de 3,24 (DE 0,37 puntos). No se encontraron diferencias estadísticamente significativas en la puntuación final del CEQ-E entre las mujeres con parto espontáneo frente a inducciones-estimulaciones (p = 0,563) ni entre mujeres primíparas frente a multíparas (p = 0,060).Las mujeres cuyo parto había sido menor o igual a 12 h (p = 0,024), sin traumatismo perineal (p = 0,021) y aquellas a las que no se les ha realizado episiotomía (p = 0,002) obtuvieron mejor puntuación final en el CEQ-E. El parto instrumental (fórceps) frente al parto eutócico se asocia a puntuaciones menores respecto a la puntuación final en el CEQ-E (p≤0,001). CONCLUSIONES: La satisfacción global de la gestante tras el parto en el HUMIC es alta. El parto instrumental parece asociarse a menor satisfacción percibida. Aspectos como el miedo y el cansancio en el parto pueden influir negativamente en la satisfacción. Estos aspectos son susceptibles de mejora mediante el establecimiento de estrategias que ayuden a mayor bienestar y minimicen el miedo de las gestantes en su parto


OBJECTIVE: To determine the degree of satisfaction of women after childbirth at the Hospital Universitario Materno-Infantil of Gran Canaria (HUMIC) and to establish possible relationships between the degree of satisfaction and the variables studied. METHOD: A cross-sectional, descriptive, observational study with an analytical component. The study population comprised women who gave birth at the HUMIC in November 2018, recruited through consecutive non-probabilistic sampling. The Spanish version of the Childbirth Experience Questionnaire (CEQ-E) was used (questionnaire with 4 domains: own capacity', professional support, perceived safety and participation/analytical model 2). In a first phase a descriptive analysis was made, and in a second phase an inferential analysis to explore the association between different variables. RESULTS: The total sample comprised 257 women (n=257). The total score using the CEQ was 3.24 (SD .37 points). No statistically significant differences were found in the final CEQ score between the women who had a spontaneous delivery versus induction-stimulation (P=.563) or between primiparous versus multiparous women (P=.060). The women whose labour lasted 12hours or less (P=.024), without perineal trauma (P=.021) and those who had not undergone episiotomy (P=.002) achieved a better final CEQ score. Instrumental delivery (forceps) versus normal delivery is associated with lower scores with respect to the final CEQ-E score (P=≤.001). CONCLUSIONS: Women's overall satisfaction after delivery in HUMIC was high. Instrumental delivery seems to be associated with lower perceived satisfaction. Aspects such as fear and fatigue in labour could affect satisfaction negatively. These aspects can be improved by establishing strategies to increase comfort and minimise pregnant women's fear of labour


Assuntos
Humanos , Feminino , Gravidez , Adolescente , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Maternidades/estatística & dados numéricos , Qualidade da Assistência à Saúde/estatística & dados numéricos , Trabalho de Parto/psicologia , Parto/psicologia , Satisfação do Paciente/estatística & dados numéricos , Centros de Assistência à Gravidez e ao Parto/estatística & dados numéricos , Parto Obstétrico/estatística & dados numéricos , Complicações do Trabalho de Parto/epidemiologia , Estudos Transversais , Episiotomia/estatística & dados numéricos , Forceps Obstétrico/estatística & dados numéricos
13.
J Perinat Neonatal Nurs ; 35(1): 29-36, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33528185

RESUMO

The objective of this evaluation was to evaluate the integration of behavioral health services at a freestanding birth center. Program evaluation included (1) retrospective health record reviews and (2) provider and client evaluation of satisfaction. In May 2017, an urban freestanding birth center initiated grant-funded integrated behavioral health services. Participants included women receiving perinatal care from May 2016 to April 2018 (n = 831). Clients (n = 414) and providers (n = 9) were surveyed through e-mail, with 166 (40%) and 7 (78%) responses, respectively. Depressive symptoms were measured with the Edinburgh Postnatal Depression Scale. Screening and treatment of depression were identified from health records. The on-site therapist saw 21% of women who birthed during the program's first year. Compared with the year before the program began, in the program's first year, more women were screened for depression at least once (401/415 (96.6%) vs 413/415 (99.5%), P = .002) and more women with an indication received treatment (62.5% [105/168] vs 34.5% [38/110], P < .001). Provider and client satisfaction was high. The on-site therapist provided services easily integrated into the freestanding birth center practice, resulting in increased depression screening and treatment, with overwhelming client and provider satisfaction.


Assuntos
Medicina do Comportamento/métodos , Centros de Assistência à Gravidez e ao Parto/organização & administração , Depressão Pós-Parto/prevenção & controle , Mães/psicologia , Assistência Perinatal/organização & administração , Adulto , Depressão Pós-Parto/diagnóstico , Feminino , Humanos , Programas de Rastreamento/métodos , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Gravidez , Avaliação de Programas e Projetos de Saúde , Escalas de Graduação Psiquiátrica
14.
J Midwifery Womens Health ; 66(4): 520-525, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-33619892

RESUMO

Perinatal care leaders at a community hospital located in the Denver, Colorado metropolitan area searched for an innovative way to provide a low-intervention option that promoted physiologic birth for women seeking intrapartum care. This reasonably priced project focused on the transformation of traditional labor and delivery rooms into birth suites and included installation of birth slings, full-size beds with home-like mattresses, new sleep sofas for the partners, and the removal of computer screens and electronic fetal monitors. In addition, the team wrote a specific birth suite policy, provided nurse education focused on intermittent auscultation and labor support techniques, and developed a birth suite curriculum for patient education. This innovative model of care demonstrated outcomes similar to those seen in community-based birth centers and received positive feedback from families who labored and gave birth in these suites. In the instance when the birth suite is no longer the appropriate environment for intrapartum care secondary to risk factors, a woman's preference, or obstetric emergency management, this model allows for expeditious transfer of the woman or newborn to a location where an appropriate higher level of care can be provided. Converting 2 labor and delivery rooms to low-intervention birth suites required minimal funding and enabled a community hospital in Colorado to expand its perinatal services to women who are seeking low-intervention birth options that promote physiologic birth.


Assuntos
Centros de Assistência à Gravidez e ao Parto , Trabalho de Parto , Parto Obstétrico , Feminino , Hospitais Comunitários , Humanos , Recém-Nascido , Parto , Gravidez
15.
Birth ; 48(2): 274-282, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-33580537

RESUMO

BACKGROUND: COVID-19 caused significant disruptions to health systems globally; however, restricting the family presence during birth saw an increase in women considering community birth options. This study aimed to quantify the hospital resource savings that could occur if all low-risk women in Australia gave birth at home or in birth centers. METHODS: A whole-of-population linked administrative data set containing all women (n = 44 498) who gave birth in Queensland, Australia, between 01/07/2012 and 30/06/2015 was reweighted to represent all Australian women giving birth in 2017. A static microsimulation model of woman and infant health service resource use was created based on 2017 data. The model was comprised of a base model, representing "current" care, and a counterfactual model, representing hypothetical scenarios where all low-risk Australian women gave birth at home or in birth centers. RESULTS: If all low-risk women gave birth at home in 2017, cesarean rates would have reduced from 13.4% to 2.7%. Similarly, there would have been 860 fewer inpatient bed days and 10.1 fewer hours of women's intensive care unit time per 1000 births. If all women gave birth in birth centers, cesarean rates would have reduced to 6.7%. In addition, over 760 inpatient bed days would have been saved along with 5.6 hours of women's intensive care unit time per 1000 births. CONCLUSIONS: Significant health resource savings could occur by shifting low-risk births from hospitals to home birth and birth center services. Greater examination of Australian women's preferences for home birth and birth center birth models of care is needed.


Assuntos
Centros de Assistência à Gravidez e ao Parto , COVID-19 , Alocação de Recursos para a Atenção à Saúde , Parto Domiciliar , Adulto , Austrália/epidemiologia , Centros de Assistência à Gravidez e ao Parto/economia , Centros de Assistência à Gravidez e ao Parto/estatística & dados numéricos , COVID-19/epidemiologia , COVID-19/prevenção & controle , Cesárea/estatística & dados numéricos , Redução de Custos/métodos , Parto Obstétrico/economia , Parto Obstétrico/métodos , Feminino , Alocação de Recursos para a Atenção à Saúde/métodos , Alocação de Recursos para a Atenção à Saúde/estatística & dados numéricos , Parto Domiciliar/economia , Parto Domiciliar/estatística & dados numéricos , Humanos , Recém-Nascido , Modelos Teóricos , Determinação de Necessidades de Cuidados de Saúde , Gravidez , SARS-CoV-2
16.
Nurs Womens Health ; 25(1): 30-42, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33453158

RESUMO

OBJECTIVE: To identify demographic and clinical factors associated with birth center clients electing hospitalization for labor and birth and to explore the timing and rationale for elective hospitalization via health records. DESIGN: A secondary analysis of multiyear data from a quality assurance project at a single birth center. We compared two subsamples-birth center preference group and hospital preference group-and described the apparent rationale for transfers among clients in the latter group. SETTING: A single freestanding birth center where all midwives have admitting privileges at a local hospital and can accompany labor transfers. PARTICIPANTS: All cases included in the analytic sample represent women with low-risk pregnancies who were eligible for birth center birth. The birth center preference group represents clients planning to give birth at the center, and the hospital preference group consists of clients who elected for hospitalization. MEASUREMENTS: Relevant demographic and clinical information was provided for the entire analytic sample and was matched with available data collected systematically by birth center staff via chart review. The data set also included anonymous responses to an e-mailed questionnaire from clients identified by birth center staff. RESULTS: Approximately 56.1% (N = 1,155) of the cases in the data set were eligible for comparative analysis. The birth center preference and hospital preference groups included 899 (77.8%) and 256 (22.2%) individuals, respectively. In the hospital preference group, Black clients (n = 23), those who were publicly insured (n = 49), and primiparas (n = 101) were significantly overrepresented. Chart review data and questionnaire responses highlighted insurance restrictions, family preferences, pain relief options, and postpartum care as influential factors among members of the hospital preference subsample. CONCLUSION: The present analysis shows associations between certain individual characteristics and elective hospitalization during labor for birth center clients. Health record data and questionnaire responses indicated a variety of reasons for electing hospitalization, illustrating the complexity of clients' decision-making during pregnancy and birth.


Assuntos
Centros de Assistência à Gravidez e ao Parto/estatística & dados numéricos , Tomada de Decisões , Hospitalização/estatística & dados numéricos , Trabalho de Parto , Parto , Preferência do Paciente/estatística & dados numéricos , Adulto , Parto Obstétrico/estatística & dados numéricos , Feminino , Humanos , Tocologia , Pennsylvania , Gravidez , Inquéritos e Questionários , Adulto Jovem
17.
PLoS One ; 16(1): e0245196, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33444424

RESUMO

OBJECTIVE: To assess the feasibility of the application of International Classification of Diseases-10-to perinatal mortality (ICD-PM) in a busy low-income referral hospital and determine the timing and causes of perinatal deaths, and associated maternal conditions. DESIGN: Prospective application of ICD-PM. SETTING: Referral hospital of Mnazi Mmoja Hospital, Zanzibar, United Republic of Tanzania. POPULATION: Stillbirths and neonatal deaths with a birth weight above 1000 grams born between October 16th 2017 to May 31st 2018. METHODS: Clinical information and an adapted WHO ICD-PM interactive excel-based system were used to capture and classify the deaths according to timing, causes and associated maternal complications. Descriptive analysis was performed. MAIN OUTCOME MEASURES: Timing and causes of perinatal mortality and their associated maternal conditions. RESULTS: There were 661 perinatal deaths of which 248 (37.5%) were neonatal deaths and 413 (62.5%) stillbirths. Of the stillbirths, 128 (31%) occurred antepartum, 129 (31%) intrapartum and for 156 (38%) the timing was unknown. Half (n = 64/128) of the antepartum stillbirths were unexplained. Two-thirds (67%, n = 87/129) of intrapartum stillbirths followed acute intrapartum events, and 30% (39/129) were unexplained. Of the neonatal deaths, 40% died after complications of intrapartum events. CONCLUSION: Problems of documentation, lack of perinatal death audits, capacity for investigations, and guidelines for the unambiguous objective assignment of timing and primary causes of death are major threats for accurate determination of timing and specific primary causes of perinatal deaths.


Assuntos
Centros de Assistência à Gravidez e ao Parto , Mortalidade Perinatal , Adulto , Causas de Morte , Feminino , Humanos , Recém-Nascido , Gravidez , Estudos Prospectivos , Tanzânia/epidemiologia
18.
Women Birth ; 34(1): e84-e91, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32518041

RESUMO

BACKGROUND: Birth Centres (BC) are underpinned by a philosophy of woman- centred care and were pivotal in growing models of midwifery-led care in South Australia (SA). AIM: To describe BC utilisation and the growth of midwifery-led care in SA over the past two decades. METHODS: The SA Perinatal Statistics Collection was used to describe women birthing from 1998 to 2016. Number of births through midwifery-led services from 2004 to 2016 were obtained from unit managers. Analyses are descriptive. FINDINGS: Women who birthed in BC in SA from 1998 to 2016 comprised approximately 6% of all births per year, and numbers have remained static. Three BC models operate in SA, all with different capacity. Proportionally, women not born in Australia are as likely to birth in BC as labour wards. The proportion of women who received midwifery-led care (whether affiliated with a BC or not), increased from 8.3% in 1998 to 19.2% of all births in 2016. Of the women who received midwifery-led care in 2016, 15.3% went on to birth in a midwifery-led model of care. CONCLUSION: Whilst the overall number of BC births has not increased, women seeking midwifery-led care has more than doubled over the past two decades. BC encompass the midwifery philosophy, quality of care, and a physical home-like environment. The BC models in SA are managed through the three tertiary maternity units enabling women to access publicly funded midwifery care and should be more widely available.


Assuntos
Centros de Assistência à Gravidez e ao Parto/estatística & dados numéricos , Tocologia/estatística & dados numéricos , Cuidado Pré-Natal/estatística & dados numéricos , Adulto , Austrália , Feminino , Humanos , Recém-Nascido , Tocologia/tendências , Parto , Gravidez , Cuidado Pré-Natal/tendências , Austrália do Sul
19.
Women Birth ; 34(3): e279-e285, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-32434683

RESUMO

PROBLEMS: Complications for newborns and postpartum clients in the hospital are more frequent after a prolonged second stage of labour. Midwives in community settings have little research to guide management in their settings. AIM: We explored how US birth centre midwives identify onset of second stage of labour and determine when to transfer clients to the hospital for prolonged second stage. METHODS: Ethnographic interviews of midwives with at least 2 years' experience in birth centres and participant observation of birth centre care. FINDINGS: We interviewed 21 midwives (18 CNMs, 3 CPMs/equivalent) from 18 birth centres in 11 US states, 45% with hospital practice privileges. Midwives relied on and engaged in embodied practice in evaluating each labour and making decisions concerning management of labour. Midwives considered time a useful but limited measure as a guiding factor in management. Though ideas of time and progress do play an important role in the decision-making process of midwives, their usefulness is limited due to the continual, multifactorial, and multisensory nature of the assessment. Relationship with the transfer hospital structured midwives' decision-making about transfers. DISCUSSION & CONCLUSION: These findings can inform future robust multivariate evaluation of factors, including but not limited to time, in guidelines for management of second stage of labour. Optimal management may require formal consideration of more than just time and parity. Our findings also suggest the need for evaluation of how structural issues involving hospital privileges for midwives and relationships between birth centre and hospital staff affect the well-being of childbearing families.


Assuntos
Centros de Assistência à Gravidez e ao Parto , Parto Obstétrico/psicologia , Segunda Fase do Trabalho de Parto , Tocologia/métodos , Enfermeiras Obstétricas/psicologia , Complicações do Trabalho de Parto/psicologia , Transferência de Pacientes/estatística & dados numéricos , Adulto , Antropologia Cultural , Austrália , Centros de Assistência à Gravidez e ao Parto/organização & administração , Continuidade da Assistência ao Paciente , Feminino , Humanos , Recém-Nascido , Entrevistas como Assunto , Segunda Fase do Trabalho de Parto/psicologia , Obstetrícia , Gravidez , Pesquisa Qualitativa , Fatores de Tempo
20.
Midwifery ; 93: 102882, 2021 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-33242702

RESUMO

BACKGROUND: Midwifery centres have been identified in over 56 countries. Consensus was reached on a global definition for midwifery centres, yet there is a lack of standards to assure consistent quality of care is provided. METHODS: Evidence-based standards and guidelines developed from American Association of Birth Centres (USA), Midwifery Unity Network (UK/EU), World Health Organization, International Childbirth Initiative, and White Ribbon Alliance, were gathered, duplicate standards were removed, and language was adapted for global use with sensitivity to low and middle countries (LMIC). An initial list of 52 midwifery centre standards were identified. Through an informal modified Delphi process these were reviewed by global midwifery centres experts, researchers, and midwifery centre staff at focus groups in Haiti, Mexico and Bangladesh for significance, language, and usability. The standards were then piloted at midwifery centres in eight countries (Sierra Leone, Cambodia, Bangladesh, Mexico, Haiti, Peru, Uganda and Trinidad). All feedback was incorporated into the final standards. RESULTS: A final list of 43 standards, organized into 3 domains including quality standards for care providers, dignity standards for women, and community standards for administration, were agreed on. CONCLUSION: Midwifery centres are prevalent around the globe. Identifying standards for quality of care provides a foundation for the midwifery centre model to be replicated and ensure consistent quality of care. Evidence based standards for midwifery centres in LMIC, allows systems to embrace and encourage the implementation and growth of midwifery centres to address accessible, acceptable, respectful, woman-centred, community-engaged maternal health care that participates fully in the health care system.


Assuntos
Tocologia/normas , Cuidados de Enfermagem/métodos , Padrões de Referência , Bangladesh , Centros de Assistência à Gravidez e ao Parto/organização & administração , Centros de Assistência à Gravidez e ao Parto/tendências , Técnica Delfos , Grupos Focais/métodos , Haiti , Humanos , México , Tocologia/tendências , Cuidados de Enfermagem/tendências , Peru , Pesquisa Qualitativa , Melhoria de Qualidade , Serra Leoa , Trinidad e Tobago , Uganda
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