Out-of-Hospital Birth.

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.

Efectos maternos y neonatales del parto en el agua. Una revisión sistemática / Maternal and neonatal effects of water birth. A systematic review

El objetivo de esta revisión bibliográfica es determinar los efectos de la inmersión en el agua durante el parto, tanto a nivel materno como neonatal. Para ello se llevó a cabo una revisión bibliográfica en las bases de datos Pubmed, Medline, Scopus y Cinahl. Los términos de búsqueda empleados fueron: "Water", "Delivery, Obstetric", "Labor, Obstetric", "Parturition" y "waterbirth". Se obtuvieron 526 resultados publicados en los últimos 5 años, de los cuales 13 artículos fueron seleccionados atendiendo a los criterios de inclusión y exclusión. Los estudios pretenden evaluar los resultados maternos y/o neonatales tras la inmersión en el agua durante el parto, aunque alguno de ellos solo se centra en uno de estos dos aspectos. Como conclusión el parto acuático proporciona a nivel materno una disminución del dolor y de la duración del parto. A nivel neonatal, no se encuentran efectos adversos para los recién nacidos

The objective of this literature review is to determine the maternal and neonatal effects of immersion in water during childbirth. A literature review was carried out in the PubMed, Medline, Scopus, and Cinahl databases. The search terms used were: "Water", "Delivery", "Obstetrics", "Labour", "Parturition", and "water birth". A total of 526 results published in the last 5 years were obtained, of which 13 articles were selected according to the inclusion and exclusion criteria. The studies aimed to evaluate maternal and / or neonatal outcomes after immersion in water during childbirth, although some of them only focus on one of these two aspects. In conclusion, immersion in water provides a reduction in pain and in the duration of labour at maternal level. At neonatal level, no adverse effects are found in newborns

Nacer en los tiempos del COVID-19 / Born in the time of COVID-19

Nos hallamos ante una situación epidemiológica causada por un coronavirus del cual todavía desconocemos muchos datos. Pese a esa carencia de información, los sistemas sanitarios están implantando protocolos para intentar proteger no sólo a los pacientes, si no a los sanitarios que en ellos trabajan. Además, tampoco sabemos demasiado del impacto del COVID-19 sobre poblaciones teóricamente más vulnerables, como las gestantes, en las cual se hace más necesario si cabe adoptar protocolos de actuación lo más basados en la evidencia posible para no caer en una deshumanización en su atención

We are facing a epidemiological situation caused by a coronavirus for which we still don't know much data. Despite this lack of information, health systems are implementing protocols to try to protect the patients, and also its health workers. Furthermore, we also don't know too much about the theoric impact of COVID-19 on vulnerable populations, such pregnant women, in which it becomes more necessary if it possible to adopt evidence-based protocols and not to fall into dehumanized treatment

Childbirth care in Egypt: a repeat cross-sectional analysis using Demographic and Health Surveys between 1995 and 2014 examining use of care, provider mix and immediate postpartum care content.

BACKGROUND: Egypt has achieved important reductions in maternal and neonatal mortality and experienced increases in the proportion of births attended by skilled professionals. However, substandard care has been highlighted as one of the avoidable causes behind persisting maternal deaths. This paper describes changes over time in the use of childbirth care in Egypt, focusing on location and sector of provision (public versus private) and the content of immediate postpartum care. METHODS: We used five Demographic and Health Surveys conducted in Egypt between 1995 and 2014 to explore national and regional trends in childbirth care. To assess content of care in 2014, we calculated the caesarean section rate and the percentage of women delivering in a facility who reported receiving four components of immediate postpartum care for themselves and their newborn. RESULTS: Between 1995 and 2014, the percentage of women delivering in health facilities increased from 35 to 87% and women delivering with a skilled birth attendant from 49 to 92%. The percentage of women delivering in a private facility nearly quadrupled from 16 to 63%. In 2010-2014, fewer than 2% of women delivering in public or private facilities received all four immediate postpartum care components measured. CONCLUSIONS: Egypt achieved large increases in the percentage of women delivering in facilities and with skilled birth attendants. However, most women and newborns did not receive essential elements of high quality immediate postpartum care. The large shift to private facilities may highlight failures of public providers to meet women's expectations. Additionally, the content (quality) of childbirth care needs to improve in both sectors. Immediate action is required to understand and address the drivers of poor quality, including insufficient resources, perverse incentives, poor compliance and enforcement of existing standards, and providers' behaviours moving between private and public sectors. Otherwise, Egypt risks undermining the benefits of high coverage because of substandard quality childbirth care.

Plan de nacimiento: una mirada de los profesionales de la salud en Portugal / Birth plan: a look of the health professionals in Portugal

Introduction: The birth plan (BP) is a written document prepared by the couple to express their wishes regarding birth. It has been the subject of health studies, although in Portugal there is a lack of research. Objective: To identify the perception of health professionals (HP) about the BP in Portugal. Methods: qualitative, exploratory, descriptive study with self-completed questionnaire on an online platform. Anonymity and confidentiality guaranteed. We used the content analysis according to Bardin and the INVivo12 tool. The non-probabilistic, intentional sample with 44 nurses midwives. Results and discussion: The BP was associated with the descriptors: empowerment and decision, humanization, choice and respect. 72.7% informed the woman/couple during the prenatal appointment and in childbirth classes. 47.7% assisted in its construction; 50% reported difficulties due to lack of model, non-acceptance and fears of HP reactions. 93.1% thought that their presentation to the team is important; 63.6% considered that BP isn't respected in maternities for institutional and professional reasons; 90.9% considered that the HP reacts in several ways to the presentation of the BP, from the devaluation to the need for its institutionalization. The results show that, although we are in different stages of BP implementation, the difficulties presented are similar to those developed in Europe. Conclusions: The results show that the HP recognize the advantages of the BP as a facilitating and reorientation strategy for women/couples in childbirth, promoting respectful and citizen-centered care. From conception to implementation, the BP seems to be a still incipient practice in Portugal. The HP considers necessary to create policies for the implementation and development of BP, important for citizens as well as for the HP

No disponible

Breast Cancer Screening Among Women by Nativity, Birthplace, and Length of Time in the United States.

Objective-The U.S. Preventive Services Task Force (USPSTF) recommends biennial mammography screening for women aged 50-74 to reduce mortality from breast cancer. In the United States, foreign-born women have historically had higher breast cancer mortality rates than their U.S.-born peers. This report presents national estimates of mammography screening among women by nativity, birthplace, and percentage of lifetime living in the United States. Methods-Combined data were analyzed from 29,951 women aged 50-74 years who participated in the 2005, 2008, 2010, 2013, and 2015 National Health Interview Survey. The percentage of these women who ever had a mammogram and met the USPSTF recommendations for screening by nativity, birthplace, and percentage of lifetime in the United States was generated. Estimates were adjusted for selected demographic, socioeconomic, and health care access and utilization factors and presented as predictive margins. Results-Overall, foreign-born women were less likely than U.S.-born women to have ever had a mammogram (88.3% compared with 94.1%). Foreign-born women living in the United States for less than 25% of their lifetime were less likely to have ever had a mammogram (76.4%) or meet the USPSTF recommendations (55.0%) compared with U.S.-born women. Foreign-born women living in the United States for 25% or more of their lifetime were also less likely to have ever had a mammogram (90.9%) compared with U.S.-born women. After adjustment for selected sociodemographic characteristics, the percentage of foreign-born women who ever received a mammogram increased but was still lower than that of U.S.-born women. Foreign-born women residing in the United States for less than 25% of their lifetime were as likely as U.S.-born women to have met the USPSTF recommendations (72.1% and 72.4%, respectively), while those residing in the United States for 25% or more of their lifetime (75.1%) were more likely to do so than U.S.-born women. Differences by birthplace were also observed.

Outcomes by birth setting and caregiver for low risk women in Indonesia: a systematic literature review.

BACKGROUND: Care for women during pregnancy, labour, birth and the postpartum period is essential to reducing maternal and neonatal mortality and morbidity, however the ideal place and organisation of care provision has not been established. The World Health Organization recommends a two-tier maternity care system involving first-level care in community facilities, with backup obstetric hospital care. However, evidence from high-income countries is increasingly showing benefits for low risk women birthing outside of hospital with skilled birth assistance and access to backup care, including lower rates of intervention. Indonesia is a lower middle-income country with a network of village based midwives who attend births at homes, clinics and hospitals, and has reduced mortality rates in recent decades while maintaining largely low rates of intervention. However, the country has not met its neonatal or maternal mortality reduction goals, and it is unclear whether greater improvements could be made if all women birthed in hospital. BODY: This paper reviewed the literature on birth outcomes by place of birth and/or caregiver for women considering their risk of complications in Indonesia. A systematic literature search of Pubmed, CINAHL, CENTRAL, Web of Science, Popline, WHOLIS and clinical trials registers in 2016 and updated in 2018 resulted in screening 2211 studies after removing duplicates. Twenty four studies were found to present outcomes by place of birth or caregiver and were included. The studies were varied in their findings with respect of the outcomes for women birthing at home and in hospital, with and without skilled care. The quality of most studies was rated as poor or moderate using the Effective Public Health Practice Project Quality Assessment Tool. Only one study gave an overall assessment of the risk status of the women included, making it impossible to draw conclusions about outcomes for low risk women specifically; other studies adjusted for various individual risk factors. CONCLUSION: From the studies in this review, it is impossible to assess the outcomes for low risk women birthing with health professionals within and outside of Indonesian hospitals. This finding is supported by reviews from other countries with developing maternity systems. Better evidence and information is needed before determinations can be made about whether attended birth outside of hospitals is a safe option for low risk women outside of high income countries.

Facility Design: Reimagining Approaches to Childbirth in Hospital and Birth Center Settings.

Few maternity care clinicians are aware of the current regulations that guide design standards for childbirth facilities in the United States or the regulatory history. There is considerable variance among state regulations as well as oversight of facility standards for healthcare settings. Understanding evidence-based recommendations on how facility design affects health outcomes is critical to reversing the rise in maternal mortality and morbidity. A variety of measures can be implemented that promise to improve user satisfaction, quality of care, and efficiency for all who engage in the childbirth environment. Recommendations for change include broader assessment to better understand how clinicians and consumers simultaneously maneuver within a complex system. Key metrics include evaluation of workflow within available space, patient acuity and census patterns, integration of evidence-based recommendations, and options that promote physiologic birth. For the changes to succeed, human centered design must be implemented and diverse clinicians and consumers engaged in all phases of planning and implementation. Exploring characteristics and outcomes of low-risk women who receive care in a freestanding birth center or the European alongside maternity unit provides opportunity to reimagine and address improvements for inpatient, hospital birth.

Effect of Increasing Malpractice Insurance Cost and Subsequent Practice of Defensive Medicine on Out-of-Hospital Birth Rates in the United States.

BACKGROUND: Across the United States, the burden of malpractice litigation has influenced obstetricians and obstetric institutions to avoid high-risk patients, favor cesarean delivery, and decrease availability of trial of labor after cesarean. Recently, the United States has experienced an increase in out-of-hospital (OOH) births. OBJECTIVE: The main purpose of this article is to investigate the association between malpractice insurance premium (MIP) and OOH births in the United States from 2000 to 2014. STUDY DESIGN: We analyzed changes in OOH birth rates and MIP from 2000 to 2014 using birth data from the National Vital Statistics System and Medical Liability Monitor's annual survey, respectively. The change in OOH birth rates was then compared with the change in MIP. RESULTS: Between 2000 and 2014, there has been approximately 60% increase in MIP from national average of $40,949 to $65,210 (p < 0.05). OOH births increased 57% from 39,398 births to 59,674 births (p < 0.05). There was a significant positive correlation between increase in MIP and increase in OOH births (p < 0.05, R 2 = 0.14). CONCLUSION: MIP and OOH birth rates have a significantly associated increase from 2000 to 2014. Given that malpractice climate affects other aspects of obstetric practice, we cautiously propose that increasing MIP may be associated with an increase in OOH births.

Correlates of home and hospital delivery in Pakistan.

OBJECTIVE: To identify the socio-economic determinants of home-based and institutional delivery in Pakistan. METHODS: This study has used Pakistan Demographic and Health Survey (PDHS) data collected by the National Institute of Population Studies (NIPS), Islamabad, Pakistan, and Macro International Inc. (now ICF International) Calverton, Maryland, United States. It used three episodes of Pakistan Demographic and Health Survey Data from 1990-91, 2006-07 and 2012-13. Data was analysed using descriptive analysis and odds of delivering at hospital were calculated using logistic regression analysis. RESULTS: Home-based delivery was over 4 times higher in 1990-91 compared with institutional delivery 5,465(85.3%) vs. 852(13.3%), and around 2 times higher in 2006-07 5,900(64.7%) vs. 3,128(34.3%). However, in 2012-13, the share of women delivering at home or health facility was roughly the same, i.e. 6,180(51.6%) at home and 5,773(48.2%) at health facility. CONCLUSIONS: There were wide gaps in the rates of institutional delivery among different subgroups, and they were accentuated by the socio-economic and financial disparities, and high illiteracy rates in the lowest wealth quintiles.