To explore a once successful rural maternity care program and the variables surrounding its closure.
Analysis of archived logbook data, reports, and communications with medical staff.
Bella Bella, a Heiltsuk First Nation community on British Columbia's central coast.
Every patient delivering at the Bella Bella hospital since 1928.
We extracted delivery rates, cesarean section rates, and local perinatal and maternal mortality rates from the hospital logbooks. In 2003, a consultant's report reviewed the viability of surgical and maternity care services in Bella Bella; this was also reviewed. Finally, several personal communications with past and present medical staff added to an understanding of the issues that initially sustained and, in the end, closed the local maternity care program.
Bella Bella had an intrapartum service with operative backup, and intervention and perinatal mortality rates were comparable to national data. There was only 1 maternal death in 80 years of intrapartum service. In the 1990 s, with sparse cesarean section coverage, more mothers were obliged to travel to referral centres, until an eventual closure of the intrapartum care service in 2001.
Bella Bella provided safe and comprehensive maternity care until, in the context of an insufficient supply of family medicine generalists trained in anesthesia, surgery, and maternity care, the service closed.
Fødestuene utgjør en del av en differensiert og desentralisert fødselsomsorg i Norge. Hensikten med studien var å undersøke forekomst og karakteristika ved planlagte og ikke-planlagte fødestuefødsler og årsaker til overflytting samt resultater for mor og barn.
I perioden 2008-10 ble et tilleggsskjema til rutinemeldingen til Medisinsk fødselsregister fortløpende utfylt av jordmor for 2 514 av i alt 2 556 (98,4 %) fødestuefødsler og for 220 fødsler som var planlagt i fødestue, men der fødselen foregikk andre steder. Data fra tilleggsskjema ble så koblet med rutinedata i Medisinsk fødselsregister og resultater fra fødestuefødsler sammenlignet med resultater fra en lavrisikofødepopulasjon i sykehus.
Av de 2 514 fødestuefødslene var 2 320 (92,3 %) planlagt å foregå der, mens 194 (7,7 %) ikke var det. Ved planlagt fødestuefødsel ble totalt 6,9 % overflyttet til sykehus under fødsel, hvorav 19,5 % blant førstegangsfødende. Det var 0,4 % operative vaginale fødsler ved vanlige fødestuer, 3,5 % ved forsterkede fødestuer og 12,7 % ved fødsler overflyttet fra fødestue til sykehus. Blant barn født i fødestue hadde 0,6 % apgarskår
CommentIn: Tidsskr Nor Laegeforen. 2018 Jun 12;138(10): PMID 29893095
Breastfeeding provides optimal nutrition for infants and is associated with decreased risk for infant and maternal morbidity and mortality; however, only four states (Alaska, Montana, Oregon, and Washington) have met all five Healthy People 2010 targets for breastfeeding. Maternity practices in hospitals and birth centers throughout the intrapartum period, such as ensuring mother-newborn skin-to-skin contact, keeping mother and newborn together, and not giving supplemental feedings to breastfed newborns unless medically indicated, can influence breastfeeding behaviors during a period critical to successful establishment of lactation. In 2007, to characterize maternity practices related to breastfeeding, CDC conducted the first national Maternity Practices in Infant Nutrition and Care (mPINC) Survey. This report summarizes results of that survey, which indicated that 1) a substantial proportion of facilities used maternity practices that are not evidence-based and are known to interfere with breastfeeding and 2) states in the southern United States generally had lower mPINC scores, including certain states previously determined to have the lowest 6-month breastfeeding rates. These results highlight the need for U.S. hospitals and birth centers to implement changes in maternity practices that support breastfeeding.
Social inequity in perinatal and maternal health is a well-documented health problem even in countries with a high level of social equality. We aimed to study whether the effect of birthplace on perinatal and maternal morbidity, birth interventions and use of pain relief among low risk women intending to give birth in two freestanding midwifery units (FMU) versus two obstetric units in Denmark differed by level of social disadvantage.
The study was designed as a cohort study with a matched control group. It included 839 low-risk women intending to give birth in an FMU, who were prospectively and individually matched on nine selected obstetric/socio-economic factors to 839 low-risk women intending OU birth. Educational level was chosen as a proxy for social position. Analysis was by intention-to-treat.
Women intending to give birth in an FMU had a significantly higher likelihood of uncomplicated, spontaneous birth with good outcomes for mother and infant compared to women intending to give birth in an OU. The likelihood of intact perineum, use of upright position for birth and water birth was also higher. No difference was found in perinatal morbidity or third/fourth degree tears, while birth interventions including caesarean section and epidural analgesia were significantly less frequent among women intending to give birth in an FMU. In our sample of healthy low-risk women with spontaneous onset of labour at term after an uncomplicated pregnancy, the positive results of intending to give birth in an FMU as compared to an OU were found to hold for both women with post-secondary education and the potentially vulnerable group of FMU women without post-secondary education. In all cases, women without post-secondary education intending to give birth in an FMU had comparable and, in some respects, more favourable outcomes when compared to women with the same level of education intending to give birth in an OU. In this sample of low-risk women, we found that the effect of intended place on birth outcomes did not differ with women's level of education.
FMU care appears to offer important benefits for birthing women with no additional risk to the infant. Both for women with and without post-secondary education, intending to give birth in an FMU significantly increased the likelihood of a spontaneous, uncomplicated birth with good outcomes for mother and infant compared to women intending to give birth in an OU. All women should be provided with adequate information about different care models and supported in making an informed decision about the place of birth.
Previous studies that compared outcomes of infants born outside tertiary care centers (outborn) with those born in tertiary care centers (inborn) did not account for admission illness severity and perinatal risks. The objective of this study was to examine whether outborn status is associated with higher mortality and morbidity, after adjustment for perinatal risks and admission illness severity (using the Score for Neonatal Acute Physiology, Version II [SNAP-II]) among preterm infants who were admitted to Neonatal Intensive Care Units (NICUs).
Logistic regression analysis was used to compare the risk-adjusted outcomes of 3769 singleton infants born at or before 32 weeks' gestation, who were admitted to 17 Canadian NICUs during 1996-1997.
Outborn and inborn infants had significantly different gestational ages, perinatal risk factors (maternal hypertension, prenatal care, antenatal corticosteroid therapy, 5-minute Apgar score, delivery type, small for gestational age) and admission SNAP-II. Outborn infants were at higher risk of death (adjusted odds ratio [OR] 1.7, 95% confidence interval [CI] 1.2, 2.5), grade III or IV intraventricular hemorrhage (adjusted OR 2.2, 95% CI 1.5, 3.2), patent ductus arteriosus (adjusted OR 1.6, 95% CI 1.2, 2.1), respiratory distress syndrome (adjusted OR 4.8, 95% CI 3.6, 6.3), and nosocomial infection (adjusted OR 2.5, 95% CI 1.9, 3.3), even after adjusting for perinatal risks and admission illness severity.
Outborn infants were less mature and more ill than inborn infants at NICU admission. However, even after adjustment for perinatal risks and admission illness severity, inborn infants had better outcomes than outborn infants. Our results support in-utero transfer of high-risk pregnancies to a tertiary level facility.
The authors argue that birth centres provide quality maternity care to healthy childbearing families at a lower cost than traditional hospital-based obstetrical services. They review the findings of two studies relating to birth centres in British Columbia: a survey of interest in birth centres among women of childbearing age and a survey of providers' opinions about possible features of a birth centre. Forces for and against the implementation of birth centres across Canada are identified.