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20/6/2005 16:33 Ilana Shemesh, natural midwife מאת: Original article abstract in English כותרת: BMJ 2005;330 (18 June), doi:10.1136/bmj.330.7505.0-a Giving birth: home can be better than hospital For women with low risk pregnancies in North America, giving birth at home bears similar risks of intrapartum and neonatal mortality as giving birth in hospital, but planned home births are associated with lower rates of medical interventions. In a prospective cohort study, Johnson and Daviss (p 1416) evaluated the safety of home births involving certified midwives in 5418 women who intended to give birth at home when labour began. The study participants experienced substantially lower rates of epidurals, episiotomies, forceps deliveries, vacuum extractions, and caesarean sections than women with low risk pregnancies who gave birth in hospital. Credit: MARK CLARKE/SPL Related Article Outcomes of planned home births with certified professional midwives: large prospective study in North America Kenneth C Johnson and Betty-Anne Daviss BMJ 2005 330: 1416. [Abstract] [Full Text] BMJ 2005;330:1416 (18 June), doi:10.1136/bmj.330.7505.1416 Paper Outcomes of planned home births with certified professional midwives: large prospective study in North America Kenneth C Johnson, senior epidemiologist1, Betty-Anne Daviss, project manager2 1 Surveillance and Risk Assessment Division, Centre for Chronic Disease Prevention and Control, Public Health Agency of Canada, PL 6702A, Ottawa, ON, Canada K1A OK9, 2 Safe Motherhood/Newborn Initiative, International Federation of Gynecology and Obstetrics, Ottawa, Canada Correspondence to: K C Johnson ken_lcdc_johnson@phac-aspc.gc.ca Abstract Objective To evaluate the safety of home births in North America involving direct entry midwives, in jurisdictions where the practice is not well integrated into the healthcare system. Design Prospective cohort study. Setting All home births involving certified professional midwives across the United States (98% of cohort) and Canada, 2000. Participants All 5418 women expecting to deliver in 2000 supported by midwives with a common certification and who planned to deliver at home when labour began. Main outcome measures Intrapartum and neonatal mortality, perinatal transfer to hospital care, medical intervention during labour, breast feeding, and maternal satisfaction. Results 655 (12.1%) women who intended to deliver at home when labour began were transferred to hospital. Medical intervention rates included epidural (4.7%), episiotomy (2.1%), forceps (1.0%), vacuum extraction (0.6%), and caesarean section (3.7%); these rates were substantially lower than for low risk US women having hospital births. 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. No mothers died. No discrepancies were found for perinatal outcomes independently validated. Conclusions Planned home birth for low risk women in North America using certified professional midwives was associated with lower rates of medical intervention but similar intrapartum and neonatal mortality to that of low risk hospital births in the United States. תוכן התגובה: תגובות נוספות 20/6/2005  22:00 תודה אילנה! (ל"ת) - Um_Netah 21/6/2005  12:53 תודה אילנה על ההפניה (ל"ת) - ענבר 21/6/2005  13:44 חדשות ממשרד הבריאות - קייטי

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