Vanessa L Scarf1, Chris Rossiter2, Saraswathi Vedam3, Hannah G Dahlen4, David Ellwood5, Della Forster6, Maralyn J Foureur7, Helen McLachlan8, Jeremy Oats9, David Sibbritt10, Charlene Thornton11, Caroline S E Homer12. 1. Centre for Midwifery, Child and Family Health, Faculty of Health, University of Technology Sydney, PO Box 123, Broadway, NSW 2007, Australia. Electronic address: Vanessa.scarf@uts.edu.au. 2. Centre for Midwifery, Child and Family Health, Faculty of Health, University of Technology Sydney, PO Box 123, Broadway, NSW 2007, Australia. Electronic address: Christine.rossiter@uts.edu.au. 3. Centre for Midwifery, Child and Family Health, Faculty of Health, University of Technology Sydney, PO Box 123, Broadway, NSW 2007, Australia; UBC Midwifery, Faculty of Medicine, University of British Columbia, 304-5950 University Boulevard, Vancouver, BC V6T 1Z3, Canada. Electronic address: saraswathi.vedam@ubc.ca. 4. School of Nursing and Midwifery, Western Sydney University, Locked Bag 1797, Penrith, NSW 2751, Australia. Electronic address: h.dahlen@westernsydney.edu.au. 5. School of Medicine, Griffith University, 170 Kessels Road, Nathan, QLD 4111, Australia. Electronic address: d.ellwood@griffith.edu.au. 6. Judith Lumley Centre, La Trobe University and the Royal Women's Hospital, 215 Franklin Street, Melbourne, VIC 3000, Australia. Electronic address: D.forster@latrobe.edu.au. 7. Centre for Midwifery, Child and Family Health, Faculty of Health, University of Technology Sydney, PO Box 123, Broadway, NSW 2007, Australia. Electronic address: Maralyn.foureur@uts.edu.au. 8. Faculty of Health Sciences, La Trobe University, Melbourne, VIC 3086, Australia. Electronic address: H.McLachlan@latrobe.edu.au. 9. Consultative Council on Obstetric and Paediatric Mortality and Morbidity, 50 Lonsdale Street, Melbourne, VIC 3000, Australia. Electronic address: jjnoats@gmail.com. 10. Centre for Midwifery, Child and Family Health, Faculty of Health, University of Technology Sydney, PO Box 123, Broadway, NSW 2007, Australia. Electronic address: david.sibbritt@uts.edu.au. 11. School of Nursing and Midwifery, Western Sydney University, Locked Bag 1797, Penrith, NSW 2751, Australia. Electronic address: c.thornton@westernsydney.edu.au. 12. Centre for Midwifery, Child and Family Health, Faculty of Health, University of Technology Sydney, PO Box 123, Broadway, NSW 2007, Australia. Electronic address: caroline.homer@uts.edu.au.
Abstract
BACKGROUND: The comparative safety of different birth settings is widely debated. Comparing research across high-income countries is complex, given differences in maternity service provision, data discrepancies, and varying research techniques and quality. Studies of births planned at home or in birth centres have reported both better and poorer outcomes than planned hospital births. Previous systematic reviews have focused on outcomes from either birth centres or home births, with inconsistent attention to quality appraisal. Few have attempted to synthesise findings. OBJECTIVE: To compare maternal and perinatal outcomes from different places of birth via a systematic review of high-quality research, and meta-analysis of appropriate data (Prospero registration CRD42016042291). DESIGN: Reviewers searched CINAHL, Embase, Maternity and Infant Care, Medline and PsycINFO databases to identify studies comparing selected outcomes by place of birth among women with low-risk pregnancies in high-income countries. They critically appraised identified studies using an instrument specific to birth place research and then combined outcome data via meta-analysis, using RevMan software. FINDINGS: Twenty-eight articles met inclusion criteria, yielding comparative data on perinatal mortality, mode of birth, maternal morbidity and/or NICU admissions. Meta-analysis indicated that women planning hospital births had statistically significantly lower odds of normal vaginal birth than in other planned settings. Women experienced severe perineal trauma or haemorrhage at a lower rate in planned home births than in obstetric units. There were no statistically significant differences in infant mortality by planned place of birth, although most studies had limited statistical power to detect differences for rare outcomes. Differences in location, context, quality and design of identified studies render results subject to variation. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: High-quality evidence about low-risk pregnancies indicates that place of birth had no statistically significant impact on infant mortality. The lower odds of maternal morbidity and obstetric intervention support the expansion of birth centre and home birth options for women with low-risk pregnancies.
BACKGROUND: The comparative safety of different birth settings is widely debated. Comparing research across high-income countries is complex, given differences in maternity service provision, data discrepancies, and varying research techniques and quality. Studies of births planned at home or in birth centres have reported both better and poorer outcomes than planned hospital births. Previous systematic reviews have focused on outcomes from either birth centres or home births, with inconsistent attention to quality appraisal. Few have attempted to synthesise findings. OBJECTIVE: To compare maternal and perinatal outcomes from different places of birth via a systematic review of high-quality research, and meta-analysis of appropriate data (Prospero registration CRD42016042291). DESIGN: Reviewers searched CINAHL, Embase, Maternity and Infant Care, Medline and PsycINFO databases to identify studies comparing selected outcomes by place of birth among women with low-risk pregnancies in high-income countries. They critically appraised identified studies using an instrument specific to birth place research and then combined outcome data via meta-analysis, using RevMan software. FINDINGS: Twenty-eight articles met inclusion criteria, yielding comparative data on perinatal mortality, mode of birth, maternal morbidity and/or NICU admissions. Meta-analysis indicated that women planning hospital births had statistically significantly lower odds of normal vaginal birth than in other planned settings. Women experienced severe perineal trauma or haemorrhage at a lower rate in planned home births than in obstetric units. There were no statistically significant differences in infant mortality by planned place of birth, although most studies had limited statistical power to detect differences for rare outcomes. Differences in location, context, quality and design of identified studies render results subject to variation. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE: High-quality evidence about low-risk pregnancies indicates that place of birth had no statistically significant impact on infant mortality. The lower odds of maternal morbidity and obstetric intervention support the expansion of birth centre and home birth options for women with low-risk pregnancies.
Authors: Nur Amani Natasha Ahmad Tajuddin; Julia Suhaimi; Siti Nurkamilla Ramdzan; Khasnur Abd Malek; Ilham Ameera Ismail; Nurainul Hana Shamsuddin; Ahmad Ihsan Abu Bakar; Sajaratulnisah Othman Journal: BMC Pregnancy Childbirth Date: 2020-05-19 Impact factor: 3.007
Authors: Benjamin Rupert Fletcher; Rachel Rowe; Jennifer Hollowell; Miranda Scanlon; Lisa Hinton; Oliver Rivero-Arias Journal: PLoS One Date: 2019-04-11 Impact factor: 3.240