The purpose of this study was to describe the characteristics of women choosing alternative maternity care compared with women who preferred conventional care. The former group of women had their antenatal, intrapartum and postpartum care at birth center in Stockholm, Sweden. Characteristics of the birth center care were continuity of care, restriction of medical technology, parental responsibility and self care. Altogether 1086 women enrolled for birth center care were included in the Alternative Group (AG). A sample of 630 was selected from among pregnant women who preferred conventional care (CG). Both groups filled in a structured questionnaire, and the response rate was 100% (1086) in the AG and 70% (441) in the CG. Besides having a more critical attitude to conventional procedures of maternity care, women in the AG were older, better educated and had other professions than CG women. They were in better physical health, and tended to be less anxious when thinking of the approaching birth and motherhood. They had more positive expectations of the coming birth, and a greater interest in not being separated from the newborn and the rest of the family immediately after the birth. They were also more interested in being actively involved in their own care. Generally speaking, AG women were more concerned about the psychological aspects of childbirth. No differences were found between the groups regarding civil status, proportion of native Swedes, or parity. Women whose characteristics coincide with those of the AG may be a growing proportion of the female population, due to better education and a growing concern about the disease orientation of maternity care.(ABSTRACT TRUNCATED AT 250 WORDS)
BACKGROUND. The objective of the study was to compare women's use of obstetric analgesia, experience of pain in labor, and other aspects of the childbirth experience at an in-hospital birth center and with standard maternity care. The birth center care was characterized by comprehensive antenatal, intrapartum and post partum care, on the same premises with a home-like environment and the same team of midwives, restricted use of medical technology and pharmacological pain relief, and discharge within 24 h after birth. METHODS. Of 1,230 women interested in birth center care and meeting low-risk medical criteria in early pregnancy, 617 were randomly allotted birth center care (EG) and 613 standard obstetric care (CG). Data were collected by questionnaires two months post partum, and hospital records. RESULTS. EG women used less pharmacological pain relief than CG women, but no difference was observed concerning the retrospective attitude to pain, or among primiparas, to the intensity of pain experienced. EG multiparas experienced pain in labor as more intense, than did CG multiparas, probably because of a more negative prenatal attitude to labor pain. EG women experienced more support from the midwife, and a greater freedom in expressing their feelings during the birth than CG women. EG primiparas were more satisfied with their own achievement and felt more involved in the birth process than CG primiparas. No differences were observed between the groups regarding overall experience of childbirth, anxiety during the birth or support from husband. CONCLUSION: Birth center care gave women interested in a natural childbirth, by avoiding pharmacological pain relief, greater opportunity to give birth according to their prenatal wishes, and it contributed to a slightly more positive birth experience.
Complaints of irritation in the eyes, nose and throat as well as dyspnea during work prompted this study to determine whether chain-saw exhaust produces acute exposure effects in loggers. Interviews concerning respiratory symptoms and rating of complaints were conducted for 211 loggers at industrial health care centers. Measurements of carboxyhemoglobin, spirometry and exposure to hydrocarbons, carbon monoxide and aldehydes were assessed for 23 loggers over 36 work periods lasting 2 h each. The prevalence of chronic bronchitis among the 211 loggers was 6%. Irritative complaints of eyes, nose and throat were common and significantly higher than in a reference group. The exposure levels were all below established threshold limit levels, except for carbon monoxide. There was a significant correlation between carbon monoxide exposure and blood carboxyhemoglobin levels. A small but significant decrease of FEV1% and FEF 25-75% during the work periods indicated minimal broncho-constriction, possibly mediated through a reflex mechanism due to irritation of upper airways.
OBJECTIVE: To compare an in-hospital birth centre with standard maternity care regarding medical interventions and maternal and infant outcome. BACKGROUND: The birth centre care was characterised by comprehensive antenatal, intrapartum and postpartum care with the same team of midwives, restricted use of medical technology, and discharge within 24 h after birth. METHODS: Of 1860 women meeting low risk medical criteria in early pregnancy and interested in birth centre care, 928 were randomly allotted birth centre care and 932 standard maternity care. Data were collected mainly from hospital records, and analysis was by intention-to-treat. RESULTS: Of the women in the birth centre group, 13% were transferred antenatally and 19% intrapartum. No statistical differences were observed in maternal morbidity or in perinatal mortality, neonatal morbidity, Apgar score or infant admissions to neonatal care. Perinatal mortality, defined as intrauterine death after 22 weeks of gestation and infant death within seven days of birth, occurred in eight cases (0.9%) in the birth centre group and in two cases (0.2%) in the standard care group (OR 4.04, 95% CI 0.80 to 39.17; P = 0.11). Subgroup analysis showed that a larger proportion of first-born babies in the birth centre group (15.6%) were admitted for neonatal care than in the standard care group (9.5%) (P = 0.003), whereas the converse was the case for the newborns of multiparous women: 4.7% and 8.4%, respectively (P = 0.04). The overall rates of operative delivery (e.g. caesarean section, vacuum extraction and forceps), 11.1% in the birth centre group and 13.4% in the standard care group, did not differ statistically (P = 0.12), but obstetric analgesia, induction, augmentation of labour and electronic fetal monitoring were less frequently used in the birth centre group. Labour was 1 h longer in the birth centre group. CONCLUSION: Birth centre care was associated with less medical interventions than standard care without any statistically significant differences in health outcomes. However, the excess of perinatal deaths and of morbidity in primigravidas' infants in the birth centre group gives cause for concern and necessitates further studies.
Increasing numbers of pregnant women take a warm bath during labor. Yet few evaluations have addressed benefits claimed and possible risks of this practice. Using retrospective data from a continuing trial at a birth center in Stockholm, we compared 89 women who took a warm bath after spontaneous rupture of the membranes at term with 89 women who had the same interval from spontaneous membrane rupture to delivery and who did not bathe. No statistical difference was observed between the groups with respect to infections, asphyxia or respiratory problems in the newborn infant, or maternal signs of amnionitis. However, a tendency toward more complications was observed in the bathing group. Babies born more than 24 hours after rupture of membranes had significantly lower Apgar scores at 5 minutes in the bathing group than in the control group. As a result of our review of the sparse literature on this practice and the data from this study, we have modified the bathing policy at the birth center from a rather enthusiastic to a more cautious approach. Recommendations about the use of a warm bath in labor will require further investigation, such as randomized trials with large numbers of subjects.