"Let us support one another, not just in philosophy but in action, for the
sake of freedom for all women to choose exactly how and by whom, if by anyone,
our bodies will be handled."
----- Original Message -----
Sent: Tuesday, May 31, 2005 9:59 PM
Subject: RE: [ozmidwifery]
MidResearch
Hi
Denise
Quite a lot of research has been done, but it is extremely difficult to
deciffer, which is good enough to be referenced - exactly what was the study
purpose (corresponding to the conclusion?), treatment of data, analyzing
comparable issues etc. Go to the Cochrane Library and check some of the
abstracts listed there and also check eventual comments from other
sources.
One
of the most famous and wellknown studies in this matter are Eksmyr's three
studies during the 1980's - first one in order to provide documentation on the
improvement of outcomes, when organizing all births at a central large unit -
he didn't find the documentation, so the sencond study was launched, this time
including a larger and transnational field - Sweden and Finland, again
it couldn't be proved that a large centralised hospital setting was better
than smal cliniques, so a Scandinavian study was launched - same conclusion as
before. Unfortunately these studies are not accesible via
Cochrane.
| Eksmyr 1986 |
| |
Eksmyr R. Two geographically defined populations with different
organization of medical care - Cause-specific analysis of early neonatal
deaths. Acta Pediatrica Scandinavia 1986;75:10-16.
Links |
|
Then i 1997 Ole Olsen and
MD Jewel did a meta study on home vs hospitals births -
Look at the comments, as most studies compare mortality, which
really isn't the most intersting perspective in this matter (very few
deaths) but rather a question of interventions and the women's percieved
quality of care. |
On
Cochrane today I found this project description to be published next year,
unfortunately, but includes contact details if that will be a
help:
[Protocol]
Midwifery-led versus other models of care delivery
for childbearing women
M Hatem, ED Hodnett, D Devane,
WD Fraser, J Sandall, H Soltani
Note in the background section of this
protocol, the authors state:
Available experimental studies suggest some benefit
for women intending to give birth within midwifery-led models of care compared
with similar risk women who intend giving birth within traditional or other
models of care (Hodnett 2003). Lower rates of intrapartum analgesia and
augmentation of labour and increased mobility during labour have been reported
(Hodnett 2003). In addition, non-experimental evidence suggests
rates of spontaneous vaginal deliveries are higher, rates of caesarean
section, episiotomy and severe perineal injury are lower, as are neonatal
admissions to special care units (Saunders 2000; Feldman 1987; Fraser 2000; Scupholme 1986). The evidence also suggests increased
satisfaction for women who are cared for within midwifery models of care
compared with traditional models of care (Turnbull 1996). However, there is a trend toward higher rates
of perinatal mortality and neonatal morbidity and mortality (stillbirth and
requirement for neonatal resuscitation) within models of midwifery-led care,
which has been suggested may result from a failure to detect deviations from
norm and/or initiate appropriate action (Fraser 2000; Hodnett 2003).
Happy hunting!
Kirsten in
Denmark
Dear All
Does any one know if Sally Tracy's Australian
research on the better outcomes of Smaller local (midwifery) materntiy units
has been published yet and if so where??
Also has anyone else here or
overseas published similar evidence supporting small or midwifery led
units??
The WA government continues to be set on
closing at least 3 metropolitan units where there are less than 1,000 births
per year and making the local women travel to birth in larger obstetric
units despite MCWA and others trying to get to the minister
and his advisors!!
More submissions and efforts are still required
so any updates of the evidence would be appreciated.
Thank you
Denise Hynd
"Let us support one another, not just in
philosophy but in action, for the sake of freedom for all women to choose
exactly how and by whom, if by anyone, our bodies will be
handled."
- Linda Hes
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