Maternal attitudes towards home birth and their effect on birth outcomes in Iceland: A prospective cohort study

The “good” epidural: Women’s use of epidurals in relation to dominant discourses on “natural” birth

Childbirth is widely recognized to be among the most painful of experiences, and the most common and effective pain relief for birthing women is known to be the use of epidural analgesia. The increase in the use of epidural analgesia for birthing women has been described by some critics as a by-product of the medicalized model of birth, although there remains a notable dearth of research regarding women’s experiences of epidurals. The present paper seeks to address this research gap by examining how first-time mothers in Iceland discuss their intentions concerning pain relief during birth, along with how they construct childbirth-related pain and the use of epidural analgesia in the context of a midwife-led model of care and an institutionalized preference for “natural” birth. The findings demonstrate that, despite initial intentions, most of the women end up having an epidural, and most describe their epidurals as both wonderful and immensely helpful. The dominant narrative about “natural” childbirth being preferable is not fully refuted by this. Instead, the women either align themselves with the ideology of the capable and knowing body or resist and contest this narrative by constructing their birthing bodies as open to, and in need of, assistance.

Low-Risk Planned Out-of-Hospital Births: Characteristics and Perinatal Outcomes in Different Italian Birth Settings

BACKGROUND

The present observational study aimed to describe women and delivery characteristics and early birth outcomes according to planned out-of-hospital delivery and to compare this information with comparable planned in-hospital deliveries.

METHODS

1099 healthy low-risk women who delivered out-of-hospital between 2014 to 2018, with a gestational age of 37-42 completed weeks of pregnancy, with single, vertex babies whose birth was expected to be vaginal and spontaneous were enrolled. Moreover, a case-control study was designed comparing characteristics of these births to a matched 1:5 sample.

RESULTS

living in a medium city (RR 1.81, 95% CI 1.19-2.74), being multiparous (RR 1.66, CI 1.09-2.51), having the first child at ≥35 years old (RR 1.84, CI 1.02-3.33), not working (RR 1.77, CI 1.06-2.96), not being omnivorous (RR 1.80, CI 1.08-3.00), and not smoking (RR 2.53, CI 1.06-6.07) were all related to an increased chance of delivering at home compared to in a freestanding midwifery unit. The significant factors in choosing to give birth out-of-hospital instead of in-hospital were living in a large or medium city (OR 2.20; 1.75-2.77; OR 2.41; 1.93-3.02) and having a secondary or higher level of education (OR > 2 for both parents). Within the first week of delivery, 6 of 1099 mothers and 19 of 1099 neonates were hospitalized.

CONCLUSIONS

out-of-hospital births in women with low-risk pregnancies is a possible option that needs to be planned, monitored, regulated, and evaluated according to healthcare control systems in order to work, as in hospitals, for the safest and most effective care to a mother and her neonate(s).

A Web-Based Form With Interactive Charts Used to Collect and Analyze Data on Home Births in Italy

Background

The use of Web-based forms and data analysis can improve the collection and visualization of data in clinical research. In Italy, no register exists that collects clinical data concerning home births.

Objective

The purpose of this study was (1) to develop a Web portal to collect, through a Web-based form, data on home births in Italy and (2) to provide those interested with a graphic visualization of the analyses and data collected.

Methods

Following the World Health Organization’s guidelines, and adding questions based on scientific evidence, the case report form (CRF) on the online form was drafted by midwives of the National Association of Out-of-Hospital Birth Midwives. During an initial phase, a group of midwives (n=10) tested the CRF, leading to improvements and adding the necessary questions to achieve a CRF that would allow a more complete collection of data. After the test phase, the entire group of midwives (n=166) registered themselves on the system and began filling out birth questionnaires. In a subsequent phase, the administrators of the portal were able to view the completed forms in a graphic format through the use of interactive maps and graphs.

Results

From 2014 to 2016, 58 midwives included 599 birth questionnaires via the Web portal; of these, 443 were home-based, 76% (321/424) of which were performed at home and 24% (103/424) at a midwifery unit. Most of the births assisted (79%, 335/424) were in northern Italy, and the average ages of the mother and father were 33.6 (SD 4.7) years and 37.0 (SD 5.6) years, respectively.

Conclusions

We developed an innovative Web-based form that allows, for the first time in Italy, the collection of data on home births and births in the midwifery unit. Furthermore, the data collected are viewable online by the midwives through interactive maps and graphs that allow them to have a general and continuously updated view of the situation of out-of-hospital births performed by the National Association of Out-of-Hospital Birth Midwives. The future goal is to be able to expand this data collection to all out-of-hospital births throughout the national territory. With an increase in the number of enrolled midwives, it would be possible to use the portal as a Web-based form and also as a portal for sharing resources that would help midwives in their clinical practice.