The study aims to describe the incidence and geographical distribution of accidental out-of-hospital births (accidental births) in Finland in relation to the changes in the hospital network, and to compare the perinatal outcomes of accidental births and all hospital births.
Data for the incidence and distribution analyses of accidental births were obtained from the official statistics between 1962 and 1973 and from the national Medical Birth Registry (MBR) in 1992-1993. The infant outcomes were analyzed for the MBR data in 1991-1995.
Between 1963 and 1975 the central hospital network expanded and by 1975 they covered 72% of births. The number of small maternity units has decreased since 1963. The incidence of accidental births decreased between 1963 and 1973, from 1.3 to 0.4 per 1000 births, and rose by the 1990s to 1/1000. In the 1990s the parity adjusted risk of an accidental birth was higher for residents of northern than of southern Finland, OR 2.51 (CI 1.75-3.60), and for residents of rural compared to urban municipalities, OR 3.26 (CI 2.48-4.27). The birthweight adjusted risk for a perinatal death was higher in accidental births than in hospital births, OR 3.11 (CI 1.42-6.84).
A temporal correlation between closing of small hospitals and an increase in accidental birth rates was detected. Due to the poor infant outcomes of accidental births, centralization policies should include measures to their prevention.
Recommendations for the dosage of naloxone to reverse opiate depression in neonates were revised by the American Academy of Pediatrics in 1989. In order to ascertain the extent to which these new recommendations have been implemented in Norway, we sent questionnaires to the maternity centres by mail. The responses from 60 different centres covered 88% of the total births in Norway in 1991. The dosages of naloxone used varied from 0.01-0.1 mg/kg, and the reported frequency of use in newborns varied between
To examine trends in obstetric interventions in women at low risk over approximately 3 years. It was postulated that there would be a general reduction in most intervention rates.
Retrospective review of hospital records.
Three downtown hospitals of the University of Toronto, in which academic and nonacademic family physicians and obstetricians practised.
A total of 2365 women in phase 1 (April 1985 to March 1986) and 1277 in phase 2 (May to September 1988) met the inclusion criteria for grade A (pregnancy at no predictable risk) of the Ontario Antenatal Record at the time of admission to hospital.
Rates of artificial rupture of the membranes, induction, augmentation, epidural anesthesia, continuous electronic fetal monitoring (EFM), instrumental delivery, episiotomy and cesarean section.
The family physicians and the obstetricians had significant decreases (p
OBJECTIVE: To identify factors predicting hospital admission in pregnancy before the delivery. DESIGN: A case-control study within a cohort study of pregnant women admitted and not admitted to hospital during pregnancy. SETTING: University obstetric departments in three Scandinavian cities. SUBJECTS: 451 parous pregnant women attending antenatal care. Eighty-eight women were admitted to hospital before delivery, and 363 women were not hospitalized. MAIN OUTCOME MEASURES: Antepartum hospital admission in pregnancy. RESULTS: There were significant differences between the groups with respect to health-related characteristics to explain the observed difference in hospital admission. Furthermore, significantly more women hospitalized in pregnancy had experienced severe life events. CONCLUSION: Factors predictive of hospital admission were identified as pregnancy complications, adverse reproductive health history, and severe life events.
Department of Nursing and Health Promotion, Oslo Metropolitan University, P.O. Box 4 St. Olavs plass, 0130 Oslo, Norway; Division of General Gynaecology and Obstetrics, Oslo University Hospital, P.O. Box 4950 Nydalen, N-0424 Oslo, Norway. Electronic address: firstname.lastname@example.org.
There is increasing evidence that fear of birth can have long-term effects on the childbearing woman and the method of birth.
To examine differences between five hospitals in Norway in the occurrence of fear of birth, counselling received and method of birth.
Source data was from the Norwegian cohort of the Bidens study and retrieved through a questionnaire and electronic patient records from five different hospitals in Oslo, Drammen, Tromsø, Ålesund and Trondheim, which included 2145 women. The Wijma Delivery Expectancy Questionnaire measured fear of birth, and a cut-off of =85 was used to define fear of birth.
In total, 12% of the women reported fear of birth, with no significant differences between the different units. A total of 8.7% received counselling according to hospital obstetrical records, varying significantly from 5.7% in Drammen to 12.7% in Oslo. Only 24.9% of the women with fear of birth had counselling at their hospital. All the units provided counselling for women with fear, but the content varied. Overarching aims included helping women develop coping strategies like writing a birth plan and clearing up issues regarding prior births. A secondary objective was to prevent unnecessary caesarean section. Both primi- and multiparous women who reported fear of birth had a twofold increased risk of a planned caesarean section.
There were no differences between five Norwegian hospitals regarding the occurrence of fear of birth. Counselling methods, resources, level of commitment and the number of women who received counselling varied; thus, hospital practices differed.
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.
OBJECTIVE. To compare the clinical indications for delivery by cesarean section (CS) in singleton pregnancies in two Danish counties with different CS rates, and to describe the relation between CS in the two counties and parity, mother's age, type of delivery department, gestational age at birth, and birthweight. DESIGN. A population-based, follow-up study based on antecedent data. SETTING. Two Danish counties, where women deliver in obstetric as well as surgical departments, with a CS rate of 8.3% and 15.2%, respectively. SUBJECTS. All pregnant women in the two counties who delivered in 1989. MAIN OUTCOME MEASURES. Comparison of the rates of CS in the two counties carried out for five well-defined clinical indications: Previous cesarean section, breech presentation, dystocia, fetal distress, and other. SECONDARY MEASURES. Neonatal and maternal outcomes. RESULTS. In the county with the higher frequency of CS, all indications for CS were used significantly more often, except from 'fetal distress' in primiparous women. In this county 'breech presentation' was the commonest indication among primiparous women, whereas 'fetal distress' was the most common in the county with the lower CS rate. For multiparous women the highest CS rates in both counties were found among women who had had a previous CS. The major difference between the two counties was the threefold greater risk of CS indicated by 'dystocia' among multiparous women in the county with the higher CS rate. CONCLUSION. The regional differences in CS could not be explained by differences between the two populations or by an increased rate of a single indication, but could be due to differences in obstetric practice or expectations or demands from the pregnant women.
In the last few years, the C-section rate has steadily increased to more than 20% in many medical centers. In 1985-1986, the obstetrical department of the Centre hospitalier universitaire de Sherbrooke, the tertiary perinatal care center for region 05, Province of Quebec, adopted a policy in favor of vaginal delivery following a previous C-section (VBAC) and vaginal delivery for breech presentation. In less than five years, this policy has brought down the C-section rate from 20 to 15% and an analysis of the data shows that this rate could even be lowered to less than 12%.