Sentences with phrase «obstetric units»

Clinical Experience, Dearborn • MI 2008 — 2011 Student / Intern Performed full - time student initiatives and performed successful clinical rotations on medical surgical, psychiatric, pediatric and obstetric units.

• Successful clinical rotations on medical surgical, psychiatric, pediatric, and obstetric units.

The most recent U.K. data for planned place of birth shows no significant differences in negative outcomes between births at home, at birth centers, and obstetric units for mothers who have already had children.

For reasons explained in the cohort study report, obstetric units contained more women in whom complicating conditions were an unexpected observation, which suggests that the risk profile of low risk women varied between the settings.

The cohort study aimed to collect data in every NHS trust in England that provides home birth services, every free standing midwifery unit, every alongside midwifery unit, and a random sample of obstetric units, stratified by unit size and geographical region, over varying periods of time within the study period (1 April 2008 to 31 April 2010).

Setting 142 of 147 trusts providing home birth services, 53 of 56 freestanding midwifery units, 43 of 51 alongside midwifery units, and a random sample of 36 of 180 obstetric units, stratified by unit size and geographical region, in England, over varying periods of time within the study period 1 April 2008 to 30 April 2010.

Fig 2 Cost effectiveness plane: planned birth at home compared with planned birth in obstetric units for nulliparous low risk women without complicating conditions at start of care in labour

At all # 10000 intervals, obstetric units were dominated by other settings and were found to have zero probability of cost effectiveness

The generalised linear model on costs showed that, even after adjustment for clinical and sociodemographic confounders, planned birth in settings other than obstetric units remained cost saving compared with the reference category of the obstetric unit: savings averaged # 134, # 130, and # 310 for planned births in alongside midwifery units, free standing midwifery units, and at home, respectively (P < 0.001)(see appendix 3 on bmj.com).

In further analyses restricted to women without complicating conditions at the start of care in labour, the adjusted odds of adverse perinatal outcomes were higher for births planned at home compared with those planned in obstetric units (adjusted odds ratio 1.59, 95 % confidence interval 1.01 to 2.52).

The adjusted odds of the secondary maternal outcomes — namely, maternal morbidity avoided and «normal birth» — were significantly increased for planned births in all three non-obstetric unit settings compared with those planned in obstetric units.

Ironically the Birthplace Study (National Perinatal Epidemiology Unit) found that labour takes nearly twice as long in obstetric units than it does in midwife - led units or at home.

The women were recruited from 142 of 147 trusts providing home birth services, 53 of 56 freestanding midwifery units, 43 of 51 alongside midwifery units, and a stratified random sample of 36 of 180 obstetric units.

Interventions Planned birth in four alternative settings: at home, in freestanding midwifery units, in alongside midwifery units, and in obstetric units.

Outcomes were compared by planned place of birth: at home, in freestanding midwifery units, in alongside midwifery units, or in obstetric units.

Among 64 538 low - risk women, of whom more than 16 000 planned a homebirth at the onset of labour, no difference was found in the adjusted odds between obstetric units and other birthplaces, including homebirth.

Of the initial sample of 37 obstetric units, five did not agree to participate and were replaced by resampling from within the same stratum, and one failed to establish data collection successfully.

Overall, there were no significant differences in the adjusted odds of the primary outcome for any of the non-obstetric unit settings compared with obstetric units.

There was no difference overall between birth settings in the incidence of the primary outcome (composite of perinatal mortality and intrapartum related neonatal morbidities), but there was a significant excess of the primary outcome in births planned at home compared with those planned in obstetric units in the restricted group of women without complicating conditions at the start of care in labour.

There are clear referral pathways to obstetric units if complications occur, using a comprehensive ambulance network with trained staff.

The stratification used in the random sampling of obstetric units was not taken into account in the analysis because obstetric units were the only unit type sampled.

Main outcome measure A composite primary outcome of perinatal mortality and intrapartum related neonatal morbidities (stillbirth after start of care in labour, early neonatal death, neonatal encephalopathy, meconium aspiration syndrome, brachial plexus injury, fractured humerus, or fractured clavicle) was used to compare outcomes by planned place of birth at the start of care in labour (at home, freestanding midwifery units, alongside midwifery units, and obstetric units).

We collected data on 79774 eligible women, of whom 64538 were low risk, from 142 (97 %) of the 147 trusts providing home birth services, 53/56 (95 %) of freestanding midwifery units, 43/51 (84 %) of alongside midwifery units, and a sample of 36 obstetric units (figure ⇓).

Overall, there were no significant differences in the odds of the primary outcome for births planned in any of the non-obstetric unit settings compared with planned births in obstetric units (table 3 ⇑).

... [T] here was a significant excess of the primary outcome in births planned at home compared with those planned in obstetric units in the restricted group of women without complicating conditions at the start of care in labour.

As of 1997, «nearly two - thirds of all women who give birth in hospitals with high - volume obstetric units had an epidural during labor.

(OU stands for Obstetric unit [hospital], AMU stands for along side maternity unit [in hospital birth center], and FMU for free - standing maternity unit [independent birth center].)

Advise low ‑ risk nulliparous women that planning to give birth in a midwifery ‑ led unit (freestanding or alongside) is particularly suitable for them because the rate of interventions is lower and the outcome for the baby is no different compared with an obstetric unit.

1.1.2 Explain to both multiparous and nulliparous women that they may choose any birth setting (home, freestanding midwifery unit, alongside midwifery unit or obstetric unit), and support them in their choice of setting wherever they choose to give birth: Advise low ‑ risk multiparous women that planning to give birth at home or in a midwifery ‑ led unit (freestanding or alongside) is particularly suitable for them because the rate of interventions is lower and the outcome for the baby is no different compared with an obstetric unit.

planning birth in an obstetric unit is associated with a higher rate of interventions, such as instrumental vaginal birth, caesarean section and episiotomy, compared with planning birth in other settings

Babies were significantly more likely to be breast fed at least once for planned births at home and at freestanding midwifery units compared with planned obstetric unit births.

In England, planned birth outside an obstetric unit remains uncommon, despite this being an available option for a number of years.

A substantial proportion of women having their first baby who plan to give birth in a non-obstetric unit setting are transferred to an obstetric unit.

These are considered to increase risk for the woman or baby, and care in an obstetric unit would be expected to reduce this risk.8

For healthy nulliparous women with a low risk pregnancy, the risk of an adverse perinatal outcome seems to be higher for planned births at home, and the intrapartum transfer rate is high in all settings other than an obstetric unit

Of women giving birth in 2007, around 8 % gave birth outside an obstetric unit — 2.8 % at home, around 3 % in alongside midwifery units, and just under 2 % in freestanding midwifery units.11

The target sample size was at least 57000 women overall: 17000 planned home births, 5000 planned alongside midwifery unit births, 5000 planned freestanding midwifery unit births, and 30000 planned obstetric unit births (of which we estimated 20000 would be low risk).

We compared each of the non-obstetric unit groups (home, freestanding midwifery unit, alongside midwifery unit) with the obstetric unit group in order to establish whether outcomes differed from the obstetric unit group in each of these settings.

For the restricted sample of women without any complicating conditions at the start of care in labour, the odds of a primary outcome event were higher for births planned at home compared with planned obstetric unit births (adjusted odds ratio 1.59, 95 % confidence interval 1.01 to 2.52) but there was no evidence of a difference for either freestanding or alongside midwifery units compared with obstetric units.

Women planning birth in a midwifery unit and multiparous women planning birth at home experience fewer interventions than those planning birth in an obstetric unit with no impact on perinatal outcomes.

Setting England: all NHS trusts providing intrapartum care at home, all freestanding midwifery units, all alongside midwifery units (midwife led units on a hospital site with an obstetric unit), and a stratified random sample of obstetric units.

For healthy multiparous women with a low risk pregnancy, there are no differences in adverse perinatal outcomes between planned births at home or in a midwifery unit compared with planned births in an obstetric unit

In the subgroup analysis stratified by parity, there was an increased incidence of the primary outcome for nulliparous women in the planned home birth group (weighted incidence 9.3 per 1000 births, 95 % confidence interval 6.5 to 13.1) compared with the obstetric unit group (weighted incidence 5.3, 3.9 to 7.3).

The study was a prospective cohort study with planned place of birth at the start of care in labour as the exposure (home, freestanding midwifery unit, alongside midwifery unit, or obstetric unit).12 Women were included in the group in which they planned to give birth at the start of care in labour regardless of whether they were transferred during labour or immediately after birth.

The characteristics of women in the freestanding midwifery unit and alongside midwifery unit groups tended to fall between the obstetric unit and home birth groups, with women in the alongside midwifery unit group generally more similar to the obstetric unit group.

Women were analysed in the group in which they planned to give birth, with the obstetric unit group as the reference.

Compared with the obstetric unit group, women planning to give birth at home were more likely to be older, white, have a fluent understanding of English, and live in a more socioeconomically advantaged area.

The proportion of women with a «normal birth» (birth without induction of labour, epidural or spinal analgesia, general anaesthesia, forceps or ventouse delivery, caesarean section, or episiotomy9 10) varied from 58 % for planned obstetric unit births to 76 % in alongside midwifery units, 83 % in freestanding midwifery units, and 88 % for planned home births; the adjusted odds of having a «normal birth» were significantly higher in all three non-obstetric unit settings (table 5 ⇓).

Incremental cost effectiveness ratios and net benefit statistics for normal birth outcome in women at low risk of complications according to planned place of birth: home, freestanding midwifery unit (FMU), or alongside midwifery unit (AMU) with obstetric unit (OU) as reference

Planned birth at home, in a free standing midwifery unit, or in an alongside midwifery unit generates incremental cost savings compared with planned birth in an obstetric unit