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20040405-29 Does a pregnant woman's intended
place of birth influence her attitudes toward and occurrence of obstetric
interventions? - Birth , vol 31, no 1, March 2004, pp 28-33 van der
Hulst LAM; van Teijlingen ER; Bonsel GJ; et
al - (2004) |
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Background: A home confinement with midwifery care is
still an integral part of Dutch maternity care. It has been argued that
the existence of home birth itself influences the course of the birth
process positively, which is why obstetric interventions are low in
comparison with neighboring countries. This study examined the impact of
women's intended place of birth (home or hospital) and the course of
pregnancy and labor when attended by midwives. Methods: This is a
prospective study of 625 low-risk pregnant women, gestation 20 to 24
weeks, enrolled in 25 independently working midwifery practices. The
course of labor was measured by the frequency of interventions by midwives
and obstetricians. Results: A more nontechnological approach to childbirth
was observed within the women opting for a home birth compared with the
women opting for a hospital birth. Data showed a relationship between
interventions and planned birth site: sweeping membranes and amniotomy by
midwives were more likely to be conducted in women opting for a home
birth. Multiparas opting for hospital birth were more likely to experience
consultations and referrals. Within the group of multiparas referred for
obstetrician care, women intending to have a home birth experienced fewer
interventions (e.g., induction, augmentation, pharmacologic pain relief,
assisted delivery, cesarean section) compared with those who had opted for
a hospital birth. Conclusions: A large proportion of women desire a home
birth. The impact of that choice demonstrated a smoother course of the
birth process, compared with women who desired to deliver in the hospital,
as measured by fewer obstetric interventions. We suggest that
psychological factors (expectation and perceptions) influence both a
woman's decision of birthplace and the actual birth process. (26
references) (Author) |
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