International comparison of perinatal mortality (stillbirth and first week deaths according to WHO definitions) among planned home births
starting labour at home
Nearly a third of women who planned and
started their labours at home ended up being transferred as complications arose — including for instance an abnormal fetal heart rate, or if the mother required more effective pain relief in the form of an epidural.
Not exact matches
Update: It was revealed Thursday that the Ontario Ministry of
Labour will begin cracking down on unpaid interns
at magazines,
starting with Toronto Life and The Walrus.
When a number of Ontario funds —
at one point, the province was home to 46
labour - sponsored funds —
started failing due to a combination of poor investments, falling sales and rising redemptions, he scooped up several and consolidated them into the Canadian Fund.
Besides, as Izzo notes, if you look
at labour market trends, the U.S. has been adding 180,000 news jobs a month since the latest round of tapering
started in September 2012, compared to 130,000 in the prior six months.
The expectation is that if
labour doesn't progress
at a certain rate that there are risks (infection, maternal exhaustion, fetal death) associated with further waiting; that the longer
labour stalls the less likely it is to
start progressing normally (if the baby is too stuck to move after two hours of
labour, it's probably too stuck to move after two days of
labour) and there are no benefits to a long
labour.
... [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.
Infants of pregnant women
at low risk had a significantly higher risk of delivery related perinatal death (relative risk 2.33, 1.12 to 4.83), compared with infants of women
at high risk whose
labour started in secondary care under the supervision of an obstetrician.
I ended #WorldDoulaWeek the same way in which I
started it;
at a
labouring woman's side.
The World Health Organization says, «We define normal birth as: spontaneous in onset, low - risk
at the
start of
labour and remaining so throughout
labour and delivery.
'' Normal births» * for healthy women with low risk pregnancies by their planned place of birth
at start of care in
labour.
The strength of this association was increased when the sample was restricted to women with no complicating conditions
at the
start of care in
labour (adjusted odds ratio 2.80, 1.59 to 4.92).
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.
Categorised by parity for all women and restricted to those without complicating conditions
at start of care in
labour
Objective To compare perinatal outcomes, maternal outcomes, and interventions in
labour by planned place of birth
at the
start of care in
labour for women with low risk pregnancies.
Transfers during
labour or immediately after birth among healthy women with low risk pregnancies by their planned place of birth
at start of care in
labour.
Results for all women and restricted to those without complicating conditions
at start of care in
labour
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.
Before the analysis of the outcomes, the co-investigators and independent advisory group agreed to modify the analysis plan to include additional analyses of outcomes restricted to women without complicating conditions
at the
start of care in
labour.
There were marked differences between planned places of birth in the proportion of women with complicating conditions identified by the attending midwife
at the
start of care in
labour (table 1 ⇑).
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.
The strengths of the study include the ability to compare outcomes by the woman's planned place of birth
at the
start of care in
labour, the high participation of midwifery units and trusts in England, the large sample size and statistical power to detect clinically important differences in adverse perinatal outcomes, the minimisation of selection bias through achievement of a high response rate and absence of self selection bias due to non-consent, the ability to compare groups that were similar in terms of identified clinical risk (according to current clinical guidelines) and to further increase the comparability of the groups by conducting an additional analysis restricted to women with no complicating conditions identified
at the
start of care in
labour, and the ability to control for several important potential confounders.
Characteristics of healthy women with low risk pregnancies by their planned place of birth
at start of care in
labour.
The overall test for interaction (heterogeneity) was of borderline statistical significance for all women (P = 0.06), and was significant for women with no complicating conditions
at the
start of care in
labour (P = 0.03).
Data were analysed for all women and then for women without complications
at the
start of
labour.
When the phone call came
at four in the morning I knew it would be Roxanna calling to let me know that the
labour had
started.
We focused on the 5418 women who intended to deliver
at home
at the
start of
labour.
The figure provides an overview of why women left care before
labour and their intended place of birth
at the
start of
labour.
Having a first baby
at home allows
labour to unfold
at its own pace, and since the mum doesn't have to go anywhere to birth, there is less emphasis on identifying the actual
start of
labour and trying to put time limits on early contractions or surges.
Healthy, term babies of low risk mothers who were alive and well
at the
start of
labour and died due to unnecessary interventions during
labour, which means a normal
labour, progressing without delay or signs of foetal distress and an OB intervened «just because».
I was told to come to Mount Carmel hospital
at 8 am on the morning which I did, I was examined and was told I was 2 cm dilated so I had
started labour naturally, my consultant broke my waters this time though it was explained to me exactly what was going on by the most wonderful midwife in the world, Karen..
After lengthy pre-
labour,
labour finally
started but my son was posterior and we stalled
at 5 cm dilated for over 10 hours.
For some, this means a few hours in the bath
at the
start of their
labour, and for others it means delivering their babies in a birthing pool.
Emily (pictured during
labour with Indiana),
started filming her pregnancy
at 27 weeks and now admits that she wishes she'd
started sooner
Planned birth
at home in low risk women without complicating conditions
at the
start of care in
labour was associated with significant cost savings and a significant decrease in adverse perinatal outcomes avoided.
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).
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 ⇓).
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 ⇓).
This was replicated for women without complicating conditions
at the
start of care in
labour.
On the other hand, if you had a caesarean section without any
labour at all, your baby's head may be round and perfect, right from the
start.
«We found that for low - risk mothers
at the
start of their
labour it is just as safe to deliver
at home with a midwife as it is in hospital with a midwife,» said Professor Simone Buitendijk of the TNO Institute for Applied Scientific Research.
... I really emphasize very strongly with my clients about how to manage their early
labours and sleep in early
labour and I encourage them to consider Gravol [Dimenhydrinate]... for sleep, even like I said certainly the first night if they're
starting early
labour at night and even sometimes the next day like late in the day or early in the evening, if they're taking their time.
Clemmie gained her qualifications
at the University of the West of England in 2006 and
started a career in midwifery
at Southmead Maternity Unit where her she developed an interest in active
labour and water birth.
MANA stats show horrible rates of intrapartum deaths (baby alive
at start of
labour, dead during it) and perinatal deaths, babies that die in the hours or days immediately before and after birth.
If you
start having contractions it's useful to time them before you contact your midwife, so she can assess what stage of
labour you're
at.
The intrapartum and neonatal mortality among women considered
at low risk
at start of
labour, excluding deaths concerning life threatening congenital anomalies, was 1.7 deaths per 1000 planned home births, similar to risks in other studies of low risk home and hospital births in North America.
im 39 +1 and i have SPD my last baby was a week over and
labour lasted 24 mins was very painful but quick and over and done with
at the same time this time last time i was checked (2weeks ago my cervix was still long and tuby and 1 cm dialated which is because of me having kids already ive just bought some castor oil and nervas about taking it but i do nt want to be
started of not a big fan of needles just would like some advice anyone please?