Sentences with phrase «planned obstetric»

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 ⇓).

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.

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).

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.

Not exact matches

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

... [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.

Women who planned a home birth were at reduced risk of all obstetric interventions assessed and were at similar or reduced risk of adverse maternal outcomes compared with women who planned to give birth in hospital accompanied by a midwife or physician.

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.

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 ⇑).

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

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.

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).

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).

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.

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.

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.

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.

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

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

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

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 obstetrPlanned 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 obstetrplanned birth in an obstetric unit

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.

For all low risk women, bootstrapped estimates showed that planned birth in settings other than an obstetric unit was associated with cost savings and considerable stochastic uncertainty surrounding adverse perinatal outcomes.

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 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).

Switching from planned birth in an obstetric unit to midwifery units was on average cost saving and associated with a non-significant decrease in adverse perinatal outcomes.

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

For low risk women without complicating conditions at the start of care in labour, the mean incremental cost effectiveness ratios associated with switches from planned birth in obstetric unit to non-obstetric unit settings fell in the south west quadrant of the cost effectiveness plane (representing, on average, reduced costs and worse outcomes).25 The mean incremental cost effectiveness ratios ranged from # 143382 (alongside midwifery units) to # 497595 (home)(table 4 ⇓).

In this study of the cost effectiveness of alternative planned places of birth in England in women at low risk of complications before the onset of labour, we found that the cost of intrapartum and after birth care, and associated related complications, was less for births planned at home, in a free standing midwifery unit, or in an alongside midwifery unit compared with planned births in an obstetric unit.

Since the early 1990s, government policy on maternity care in England has moved towards policies designed to give women with straightforward pregnancies a choice of settings for birth.1 2 In this context, freestanding midwifery units, midwifery units located in the same building or on the same site as an obstetric unit (hereafter referred to as alongside midwifery units), and home birth services have increasingly become relevant to the configuration of maternity services under consideration in England.3 The relative benefits and risks of birth in these alternative settings have been widely debated in recent years.4 5 6 7 8 9 10 Lower rates of obstetric interventions and other positive maternal outcomes have been consistently found in planned births at home and in midwifery units, but clear conclusions regarding perinatal outcome have been lacking.

Restriction of the analyses to low risk women without complicating conditions at the start of care in labour narrowed the cost differences between planned places of birth: total mean costs were # 1511 for an obstetric unit, # 1426 for an alongside midwifery unit, # 1405 for a free standing midwifery unit, and for # 1027 the home (table 2 ⇓).

Profiles of resource use, and their associated unit costs, for each planned place of birth are reported in detail in appendices 1 and 2 on bmj.com.25 The total mean costs per low risk woman planning birth in the various settings at the start of care in labour were # 1631 ($ 1950, $ 2603) for an obstetric unit, # 1461 ($ 1747, $ 2332) for an alongside midwifery unit, # 1435 ($ 1715, $ 2290) for a free standing midwifery unit, and # 1067 ($ 1274, $ 1701) for the home (table 1 ⇓).

The authors concluded that planned home births were associated with increased neonatal complications but fewer obstetric interventions.

The ACOG Committee on Obstetric Practice's opinion on planned home birth (2011) noted that although the Committee believes that hospitals and birthing centers are the safest setting for birth, it respects the right of a woman to make a medically informed decision about delivery.

Jane Sandall was and is principal investigator for two studies evaluating models of midwife - led continuity of care (Sandall 2001), and co-investigator on the «Birthplace in England Research Programme», an integrated programme of research designed to compare outcomes of births for women planned at home, in different types of midwifery units, and in hospital units with obstetric services.

Some were listed as «suggesting planned birth at an obstetric unit» and some as «indicating individual assessment when planning place of birth».

A planned home birth might be associated with fewer medical interventions, but in general, home births are associated with an increased risk of obstetric emergencies when compared with delivery in a medical facility.

Women in the planned home - birth group were significantly less likely than those who planned a midwife - attended hospital birth to have obstetric interventions (e.g., electronic fetal monitoring, relative risk [RR] 0.32, 95 % CI 0.29 — 0.36; assisted vaginal delivery, RR 0.41, 95 % 0.33 — 0.52) or adverse maternal outcomes (e.g., third - or fourth - degree perineal tear, RR 0.41, 95 % CI 0.28 — 0.59; postpartum hemorrhage, RR 0.62, 95 % CI 0.49 — 0.77).

Compared with women who planned a hospital birth with a midwife or physician in attendance, those who planned a home birth were significantly less likely to experience any of the obstetric interventions we assessed, including electronic fetal monitoring, augmentation of labour, assisted vaginal delivery, cesarean delivery and episiotomy (Table 3).

In the subgroup analysis in which we excluded women whose labour was induced by outpatient administration of prostaglandins, amniotomy or both (118 [4.1 %] of women in the home - birth group, 344 [7.2 %] of those who planned a midwife - attended hospital birth and 778 [14.6 %] of those who planned a physician - attended hospital birth), the relative risks of obstetric interventions and adverse maternal and neonatal outcomes did not change significantly.

Our study showed that planned home birth attended by a registered midwife was associated with very low and comparable rates of perinatal death and reduced rates of obstetric interventions and adverse maternal outcomes compared with planned hospital birth attended by a midwife or physician.

Good candidates for planned TOLAC are those women in whom the balance of risks (as low as possible) and chances of success (as high as possible) are acceptable to the patient and obstetrician or other obstetric care provider.

Data comparing the rates of VBAC, as well as maternal and neonatal outcomes, after TOLAC to those after planned repeat cesarean delivery can help guide obstetricians or other obstetric care providers and patients when deciding how to approach delivery in women with a prior cesarean delivery.

Using this tool we compared the outcomes of planned home births with those of planned hospital births for primiparous and multiparous women after controlling for the confounding effects of social, medical, and obstetric background.

We wished to assess whether the planned place of birth would lead to differences in perinatal outcome after the confounding effects of obstetric, medical, and social background were controlled for.