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A Novel Method for Involving Women of Color at High Risk for Preterm Birth in Research Priority Setting
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Published on: January 12, 2018

Alternative versus conventional institutional settings for birth.

Ellen D Hodnett1, Soo Downe, Denis Walsh

  • 1Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada. ellen.hodnett@utoronto.ca

The Cochrane Database of Systematic Reviews
|August 17, 2012
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Summary

Alternative birth settings, such as hospital birth centers, are linked to fewer medical interventions and higher patient satisfaction. These settings offer a safe environment for mothers and babies, promoting natural birth experiences and improved breastfeeding outcomes.

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Area of Science:

  • Obstetrics and Gynecology
  • Maternal and Child Health
  • Healthcare Management

Background:

  • Alternative institutional settings provide options for pregnant women seeking minimal medical intervention during birth.
  • These settings range from hospital-based birth centers to freestanding entities, incorporating specialized labor room designs.

Purpose of the Study:

  • To evaluate the impact of alternative institutional birth environments compared to conventional settings.
  • To investigate if staffing, architectural features, organizational models, or location influence birth setting outcomes.

Main Methods:

  • A systematic review of randomized and quasi-randomized controlled trials was conducted.
  • Searches were performed on the Cochrane Pregnancy and Childbirth Group's Trials Register.
  • Methodological quality was assessed, and data were extracted and analyzed using risk ratios (RR) and 95% confidence intervals (CI).

Main Results:

  • Ten trials involving 11,795 women were included. Alternative settings showed increased likelihood of no intrapartum analgesia, spontaneous vaginal birth, and breastfeeding at 6-8 weeks.
  • Reduced likelihood of epidural analgesia, oxytocin augmentation, instrumental vaginal birth, and episiotomy was observed in alternative settings.
  • No significant effects on other adverse maternal or neonatal outcomes were found; confounding factors limited conclusions on architectural features and caregiver continuity.

Conclusions:

  • Hospital birth centers are associated with reduced medical interventions during labor and birth.
  • These settings correlate with higher maternal satisfaction without compromising safety for mothers or newborns.
  • Further research is needed to isolate the effects of specific environmental and organizational factors in alternative birth settings.