The Experts below are selected from a list of 255 Experts worldwide ranked by ideXlab platform
Yvonne Hauck - One of the best experts on this subject based on the ideXlab platform.
-
the woman partner and midwife an integration of three perspectives of labour when intrapartum transfer from a Birth Centre to a tertiary obstetric unit occurs
Women and Birth, 2017Co-Authors: Yvonne Hauck, Lesley Kuliukas, Lucy Lewis, Ravani DugganAbstract:Abstract Background When transfer in labour takes place from a Birth Centre to a tertiary maternity hospital the woman, her partner and the midwife (the triad) are involved, representing three different perspectives. The purpose of this paper is to explore the integration of these intrapartum transfer experiences for the Birth triad. Methods Giorgi’s descriptive phenomenological method of analysis was used to explore the ‘lived’ experiences of Western Australian women, their partners and midwives across the Birth journey. Forty-five interviews were conducted. Findings Findings revealed that experiences of intrapartum transfer were unique to each member of the triad (woman, partner and midwife) and yet there were also shared experiences. All three had three themes in common: ‘The same journey through three different lenses’; ‘In my own world’ and ‘Talking about the Birth’. The woman and partner shared two themes: ‘Lost Birth dream’ and ‘Grateful to return to a familiar environment’. The woman and midwife both had: ‘Gratitude for continuity of care model’ and the partner and midwife both found they were: ‘Struggling to adapt to a changing care model’ and their ‘Inside knowledge was not appreciated’. Conclusion Insight into the unique integrated experiences during a Birth Centre intrapartum transfer can inform midwives, empowering them to better support parents through antenatal education before and by offering discussion about the Birth and transfer after. Translation of findings to practice also reinforces how midwives can support their colleagues by recognising the accompanying midwife’s role and knowledge of the woman.
-
women s experience of intrapartum transfer from a western australian Birth Centre co located to a tertiary maternity hospital
BMC Pregnancy and Childbirth, 2016Co-Authors: Yvonne Hauck, Lesley Kuliukas, Ravani Duggan, Lucy LewisAbstract:The aim of this Western Australian study was to describe the overall labour and Birth experience of women who were transferred during the first and second stages of labour from a low risk woman-Centred, midwifery-led Birth Centre to a co-located tertiary maternity referral hospital. Using a descriptive phenomenological design, fifteen women were interviewed up to 8 weeks post Birth (July to October, 2013) to explore their experience of the intrapartum transfer. Giorgi’s method of analysis was used. The following themes and subthemes emerged: 1) The midwife’s voice with subthemes, a) The calming effect and b) Speaking up on my behalf; 2) In the zone with subthemes, a) Hanging in there and b) Post Birth rationalizing; 3) Best of both worlds with subthemes a) The feeling of relief on transfer to tertiary Birth suite and b) Returning back to the comfort and familiarity of the Birth Centre; 4) Lost sense of self; and 5) Lost Birth dream with subthemes a) Narrowing of options and b) Feeling of panic. Women found the midwife’s voice guided them through the transfer experience and were appreciative of continuity of care. There was a sense of disruption to expectations and disappointment in not achieving the labour and Birth they had anticipated. There was however appreciation that the referral facility was nearby and experts were close at hand. The focus of care altered from woman to fetus, making women feel diminished. Women were glad to return to the familiar Birth Centre after the Birth with the opportunity to talk through and fully understand their labour journey which helped them contextualise the transfer as one part of the whole experience. Findings can inform midwives of the value of a continuity of care model within a Birth Centre, allowing women both familiarity and peace of mind. Maternity care providers should ensure that the woman remains the focus of care after transfer and understand the significance of effective communication to ensure women are included in all care discussions.
-
midwives experiences of transfer in labour from a western australian Birth Centre to a tertiary maternity hospital
Women and Birth, 2016Co-Authors: Yvonne Hauck, Lesley Kuliukas, Lucy Lewis, Ravani DugganAbstract:Abstract Background When transfer in labour takes place from a woman-Centred, midwifery led Centre to a tertiary maternity hospital it is accepted that women are negatively affected, however the midwife's role is unevaluated, there is no published literature exploring their experience. This study aimed to describe these experiences. Methods Giorgi's descriptive phenomenological method of analysis was used to explore the ‘lived’ experiences of the midwives. Seventeen interviews of transferring midwives took place and data saturation was achieved. Findings The overall findings suggest that midwives find transfer in labour challenging, both emotionally and practically. Five main themes emerged: (1) ‘The midwife's internal conversation’ with subtheme: ‘Feeling under pressure’, (2) ‘Challenged to find a role in changing circumstances’ with subtheme: ‘Varying degrees of support’, (3) ‘Feeling out of place’ with subtheme: ‘Caught in the middle of different models of care, (4) ‘A constant support for the parents across the labour and Birth process’ with subthemes: ‘Acknowledging the parents’ loss of their desired Birth’ and (5) ‘The midwives’ need for debrief’. Conclusion Midwives acknowledged the challenge of finding the balance between fulfilling parents’ Birth plan wishes with hospital protocol and maintaining safety. Transfer for fetal or maternal compromise caused anxiety and concern. The benefits of providing continuity of care were acknowledged by the midwife's knowledge of the woman and her history but these were not always recognised by the receiving team. Discussing the transfer story afterwards helped midwives review their practice. Effective communication between all stakeholders is essential throughout the transfer process.
-
the phenomenon of intrapartum transfer from a western australian Birth Centre to a tertiary maternity hospital the overall experiences of partners
Midwifery, 2015Co-Authors: Yvonne Hauck, Lesley Kuliukas, Ravani Duggan, Lucy LewisAbstract:Abstract Aim the aim of this Western Australian study was to describe the overall labour and Birth experience of partners within the context of an intrapartum transfer occurring from a low risk midwifery-led, woman-Centred unit to an obstetric unit. Design a descriptive phenomenological design was used. 15 male partners were interviewed in the first 8 weeks post partum between July and October, 2013 to explore their experience of the intrapartum transfer. Setting a midwifery-led Birth Centre set on the grounds of a tertiary maternity referral hospital. Participants partners of women who were transferred from the Birth Centre to the onsite tertiary hospital due to complications during the first and second stages of labour. Findings five main themes emerged: (1) ‘emotional roller coaster'; (2) ‘partner׳s role in changing circumstances' with subthemes: ‘acknowledgement for his inside knowledge of her' and ‘challenges of being a witness'; (3) ‘adapting to a changing model of care' with subthemes: ‘moving from an inclusive nurturing and continuity model' and ‘transferring to a medicalised model'; (4) ‘adapting to environmental changes' with subthemes: ‘feeling comfortable in the familiar Birth Centre', ‘going to the place where things go wrong' and ‘Back to comfortable familiarity afterwards' and (5) ‘coming to terms with altered expectations around the labour and Birth experience'. Key conclusions partners acknowledged the benefits of midwifery continuity of care, however, noted that as partners they also provided essential continuity as they felt they knew their woman better than any care provider. Partners found it difficult to witness their woman׳s difficult labour journey. They found the change of environment from Birth Centre to labour ward challenging but appreciated that experienced medical assistance was at hand when necessary. Being able to return to the Birth Centre environment was acknowledged as beneficial for the couple. Following the transfer experience partners asked for the opportunity to debrief to clarify and better understand the process. Implications for practice findings may be used to inform partners in childBirth education classes about what to expect when transfer takes place and offer the opportunity for them to debrief after the Birth. Finally, themes can provide insight to maternity care professionals around the emotions experienced by partners during intrapartum transfer to enhance informed choice, involvement in care and empathetic support.
-
normality and collaboration mothers perceptions of Birth Centre versus hospital care
Midwifery, 2001Co-Authors: Karen L Coyle, Yvonne Hauck, Patricia Percival, Linda J KristjansonAbstract:Abstract Objective: to describe women's perceptions of care in Western Australian Birth Centres following a previous hospital Birth. Design, setting and participants: an exploratory design was used to study the care experiences of 17 women recruited from three Western Australian Birth Centres. Data were obtained from in-depth interviews that explored women's perceptions of their care in both the Birth Centre and hospital context. Findings: four key themes emerged from the analysis: ‘beliefs about pregnancy and Birth', ‘nature of the care relationship', ‘care interactions', and ‘care structures'. The themes of ‘beliefs about pregnancy and Birth' and ‘nature of the care relationship' are discussed in this paper. Beliefs about pregnancy and Birth refer to the philosophical underpinnings of pregnancy and Birth held by women and their carers. Nature of the care relationship identifies women's perceptions of their relationship with health professionals. Care interactions and care structures will be described in a subsequent paper. Key conclusions and implications for practice: The women's comments suggested differences in philosophy between hospital and Birth-Centre settings. The philosophy and beliefs of caregivers was an important component of the care experience. Women valued the normality of the Birth-Centre approach and the opportunity to experience the Birth of their child with collaborative support from a midwife.
Caroline S E Homer - One of the best experts on this subject based on the ideXlab platform.
-
mapping the trajectories for women and their babies from Births planned at home in a Birth Centre or in a hospital in new south wales australia between 2000 and 2012
BMC Pregnancy and Childbirth, 2019Co-Authors: Vanessa Scarf, Charlene Thornton, Maralyn Foureur, Hannah G Dahlen, Rosalie Viney, Chris Rossiter, Seong Leang Cheah, Caroline S E HomerAbstract:In New South Wales (NSW) Australia, women at low risk of complications can choose from three Birth settings: home, Birth Centre and hospital. Between 2000 and 2012, around 6.4% of pregnant women planned to give Birth in a Birth Centre (6%) or at home (0.4%) and 93.6% of women planned to Birth in a hospital. A proportion of the woman in the home and Birth Centre groups transferred to hospital. However, their pathways or trajectories are largely unknown. The aim was to map the trajectories and interventions experienced by women and their babies from Births planned at home, in a Birth Centre or in a hospital over a 13-year period in NSW. Using population-based linked datasets from NSW, women at low risk of complications, with singleton pregnancies, gestation 37–41 completed weeks and spontaneous onset of labour were included. We used a decision tree framework to depict the trajectories of these women and estimate the probabilities of the following: giving Birth in their planned setting; being transferred; requiring interventions and neonatal admission to higher level hospital care. The trajectories were analysed by parity. Over a 13-year period, 23% of nulliparous and 0.8% of multiparous women planning a home Birth were transferred to hospital. In the Birth Centre group, 34% of nulliparae and 12% of multiparas were transferred to a hospital. Normal vaginal Birth rates were higher in multiparous women compared to nulliparous women in all settings. Neonatal admission to SCN/NICU was highest in the planned hospital group for nulliparous women (10.1%), 7.1% for nulliparous women planning a Birth Centre Birth and 5.1% of nulliparous women planning a homeBirth. Multiparas had lower admissions to SCN/NICU for all thee settings (hospital 6.3%, BC 3.6%, home 1.6%, respectively). Women who plan to give Birth at home or in a Birth Centre have high rates of vaginal Birth, even when transferred to hospital. Evidence on the trajectories of women who choose to give Birth at home or in Birth Centres will assist the planning, costing and expansion of models of care in NSW.
-
the hardware and software implications of hospital Birth room design a midwifery perspective
Midwifery, 2014Co-Authors: Athena Hammond, Maralyn Foureur, Caroline S E HomerAbstract:Abstract Objective to explore the impacts of physical and aesthetic design of hospital Birth rooms on midwives. Background the design of a workplace, including architecture, equipment, furnishings and aesthetics, can influence the experience and performance of staff. Some research has explored the effects of workplace design in health care environments but very little research has examined the impact of design on midwives working in hospital Birth rooms. Methods a video ethnographic study was undertaken and the labours of six women cared for by midwives were filmed. Filming took place in one Birth Centre and two labour wards within two Australian hospitals. Subsequently, eight midwives participated in video-reflexive interviews whilst viewing the filmed labour of the woman for whom they provided care. Thematic analysis of the midwife interviews was undertaken. Findings midwives were strongly affected by the design of the Birth room. Four major themes were identified: finding a space amongst congestion and clutter; trying to work underwater; creating ambience in a clinical space and being equipped for flexible practice. Aesthetic features, room layout and the design of equipment and fixtures all impacted on the midwives and their practice in both Birth Centre and labour ward settings. Conclusion and implications for practice the current design of many hospital Birth rooms challenges the provision of effective midwifery practice. Changes to the design and aesthetics of the hospital Birth room may engender safer, more comfortable and more effective midwifery practice.
-
Birthplace in new south wales australia an analysis of perinatal outcomes using routinely collected data
BMC Pregnancy and Childbirth, 2014Co-Authors: Caroline S E Homer, Charlene Thornton, Vanessa Scarf, David Ellwood, Jeremy Oats, Maralyn Foureur, David Sibbritt, Helen L Mclachlan, Della Forster, Hannah G DahlenAbstract:Background: The outcomes for women who give Birth in hospital compared with at home are the subject of ongoing debate. We aimed to determine whether a retrospective linked data study using routinely collected data was a viable means to compare perinatal and maternal outcomes and interventions in labour by planned place of Birth at the onset of labour in one Australian state. Methods: A population-based cohort study was undertaken using routinely collected linked data from the New South Wales Perinatal Data Collection, Admitted Patient Data Collection, Register of Congenital Conditions, Registry of Birth Deaths and Marriages and the Australian Bureau of Statistics. Eight years of data provided a sample size of 258,161 full-term women and their infants. The primary outcome was a composite outcome of neonatal mortality and morbidity as used in the Birthplace in England study. Results: Women who planned to give Birth in a Birth Centre or at home were significantly more likely to have a normal labour and Birth compared with women in the labour ward group. There were no statistically significant differences in stillBirth and early neonatal deaths between the three groups, although we had insufficient statistical power to test reliably for these differences. Conclusion: This study provides information to assist the development and evaluation of different places of Birth across Australia. It is feasible to examine perinatal and maternal outcomes by planned place of Birth using routinely collected linked data, although very large data sets will be required to measure rare outcomes associated with place of Birth in a low risk population, especially in countries like Australia where homeBirth rates are low.
-
Birth Centre or labour ward a comparison of the clinical outcomes of low risk women in a nsw hospital
The Australian journal of advanced nursing : a quarterly publication of the Royal Australian Nursing Federation, 2000Co-Authors: Caroline S E Homer, Gregory K Davis, P Petocz, Lesley Barclay, Deborah V Matha, Michael ChapmanAbstract:A number of Birth Centres were established in New South Wales as a result of the Shearman Report (NSW Health Department 1989). The objective of this study was to compare the obstetric outcomes, primarily caesarean section rates, of low-risk women presenting in spontaneous labour to the Birth Centre with those attending the hospital's conventional labour ward. The study showed that there was no significant difference in the caesarean section rate between the groups (3.5% in the Birth Centre and 4.3% in the labour ward). We suggest that the site of Birthing does not affect clinical outcomes for low-risk women at this hospital. These results are relevant to contemporary clinical practice as they question the basis upon which Birth Centres have been popularised, that is, the medicalisation of Birth in conventional labour wards increases intervention rates.
Lesley Kuliukas - One of the best experts on this subject based on the ideXlab platform.
-
the woman partner and midwife an integration of three perspectives of labour when intrapartum transfer from a Birth Centre to a tertiary obstetric unit occurs
Women and Birth, 2017Co-Authors: Yvonne Hauck, Lesley Kuliukas, Lucy Lewis, Ravani DugganAbstract:Abstract Background When transfer in labour takes place from a Birth Centre to a tertiary maternity hospital the woman, her partner and the midwife (the triad) are involved, representing three different perspectives. The purpose of this paper is to explore the integration of these intrapartum transfer experiences for the Birth triad. Methods Giorgi’s descriptive phenomenological method of analysis was used to explore the ‘lived’ experiences of Western Australian women, their partners and midwives across the Birth journey. Forty-five interviews were conducted. Findings Findings revealed that experiences of intrapartum transfer were unique to each member of the triad (woman, partner and midwife) and yet there were also shared experiences. All three had three themes in common: ‘The same journey through three different lenses’; ‘In my own world’ and ‘Talking about the Birth’. The woman and partner shared two themes: ‘Lost Birth dream’ and ‘Grateful to return to a familiar environment’. The woman and midwife both had: ‘Gratitude for continuity of care model’ and the partner and midwife both found they were: ‘Struggling to adapt to a changing care model’ and their ‘Inside knowledge was not appreciated’. Conclusion Insight into the unique integrated experiences during a Birth Centre intrapartum transfer can inform midwives, empowering them to better support parents through antenatal education before and by offering discussion about the Birth and transfer after. Translation of findings to practice also reinforces how midwives can support their colleagues by recognising the accompanying midwife’s role and knowledge of the woman.
-
women s experience of intrapartum transfer from a western australian Birth Centre co located to a tertiary maternity hospital
BMC Pregnancy and Childbirth, 2016Co-Authors: Yvonne Hauck, Lesley Kuliukas, Ravani Duggan, Lucy LewisAbstract:The aim of this Western Australian study was to describe the overall labour and Birth experience of women who were transferred during the first and second stages of labour from a low risk woman-Centred, midwifery-led Birth Centre to a co-located tertiary maternity referral hospital. Using a descriptive phenomenological design, fifteen women were interviewed up to 8 weeks post Birth (July to October, 2013) to explore their experience of the intrapartum transfer. Giorgi’s method of analysis was used. The following themes and subthemes emerged: 1) The midwife’s voice with subthemes, a) The calming effect and b) Speaking up on my behalf; 2) In the zone with subthemes, a) Hanging in there and b) Post Birth rationalizing; 3) Best of both worlds with subthemes a) The feeling of relief on transfer to tertiary Birth suite and b) Returning back to the comfort and familiarity of the Birth Centre; 4) Lost sense of self; and 5) Lost Birth dream with subthemes a) Narrowing of options and b) Feeling of panic. Women found the midwife’s voice guided them through the transfer experience and were appreciative of continuity of care. There was a sense of disruption to expectations and disappointment in not achieving the labour and Birth they had anticipated. There was however appreciation that the referral facility was nearby and experts were close at hand. The focus of care altered from woman to fetus, making women feel diminished. Women were glad to return to the familiar Birth Centre after the Birth with the opportunity to talk through and fully understand their labour journey which helped them contextualise the transfer as one part of the whole experience. Findings can inform midwives of the value of a continuity of care model within a Birth Centre, allowing women both familiarity and peace of mind. Maternity care providers should ensure that the woman remains the focus of care after transfer and understand the significance of effective communication to ensure women are included in all care discussions.
-
midwives experiences of transfer in labour from a western australian Birth Centre to a tertiary maternity hospital
Women and Birth, 2016Co-Authors: Yvonne Hauck, Lesley Kuliukas, Lucy Lewis, Ravani DugganAbstract:Abstract Background When transfer in labour takes place from a woman-Centred, midwifery led Centre to a tertiary maternity hospital it is accepted that women are negatively affected, however the midwife's role is unevaluated, there is no published literature exploring their experience. This study aimed to describe these experiences. Methods Giorgi's descriptive phenomenological method of analysis was used to explore the ‘lived’ experiences of the midwives. Seventeen interviews of transferring midwives took place and data saturation was achieved. Findings The overall findings suggest that midwives find transfer in labour challenging, both emotionally and practically. Five main themes emerged: (1) ‘The midwife's internal conversation’ with subtheme: ‘Feeling under pressure’, (2) ‘Challenged to find a role in changing circumstances’ with subtheme: ‘Varying degrees of support’, (3) ‘Feeling out of place’ with subtheme: ‘Caught in the middle of different models of care, (4) ‘A constant support for the parents across the labour and Birth process’ with subthemes: ‘Acknowledging the parents’ loss of their desired Birth’ and (5) ‘The midwives’ need for debrief’. Conclusion Midwives acknowledged the challenge of finding the balance between fulfilling parents’ Birth plan wishes with hospital protocol and maintaining safety. Transfer for fetal or maternal compromise caused anxiety and concern. The benefits of providing continuity of care were acknowledged by the midwife's knowledge of the woman and her history but these were not always recognised by the receiving team. Discussing the transfer story afterwards helped midwives review their practice. Effective communication between all stakeholders is essential throughout the transfer process.
-
the phenomenon of intrapartum transfer from a western australian Birth Centre to a tertiary maternity hospital the overall experiences of partners
Midwifery, 2015Co-Authors: Yvonne Hauck, Lesley Kuliukas, Ravani Duggan, Lucy LewisAbstract:Abstract Aim the aim of this Western Australian study was to describe the overall labour and Birth experience of partners within the context of an intrapartum transfer occurring from a low risk midwifery-led, woman-Centred unit to an obstetric unit. Design a descriptive phenomenological design was used. 15 male partners were interviewed in the first 8 weeks post partum between July and October, 2013 to explore their experience of the intrapartum transfer. Setting a midwifery-led Birth Centre set on the grounds of a tertiary maternity referral hospital. Participants partners of women who were transferred from the Birth Centre to the onsite tertiary hospital due to complications during the first and second stages of labour. Findings five main themes emerged: (1) ‘emotional roller coaster'; (2) ‘partner׳s role in changing circumstances' with subthemes: ‘acknowledgement for his inside knowledge of her' and ‘challenges of being a witness'; (3) ‘adapting to a changing model of care' with subthemes: ‘moving from an inclusive nurturing and continuity model' and ‘transferring to a medicalised model'; (4) ‘adapting to environmental changes' with subthemes: ‘feeling comfortable in the familiar Birth Centre', ‘going to the place where things go wrong' and ‘Back to comfortable familiarity afterwards' and (5) ‘coming to terms with altered expectations around the labour and Birth experience'. Key conclusions partners acknowledged the benefits of midwifery continuity of care, however, noted that as partners they also provided essential continuity as they felt they knew their woman better than any care provider. Partners found it difficult to witness their woman׳s difficult labour journey. They found the change of environment from Birth Centre to labour ward challenging but appreciated that experienced medical assistance was at hand when necessary. Being able to return to the Birth Centre environment was acknowledged as beneficial for the couple. Following the transfer experience partners asked for the opportunity to debrief to clarify and better understand the process. Implications for practice findings may be used to inform partners in childBirth education classes about what to expect when transfer takes place and offer the opportunity for them to debrief after the Birth. Finally, themes can provide insight to maternity care professionals around the emotions experienced by partners during intrapartum transfer to enhance informed choice, involvement in care and empathetic support.
Denis Walsh - One of the best experts on this subject based on the ideXlab platform.
-
home like versus conventional institutional settings for Birth
Birth-issues in Perinatal Care, 2008Co-Authors: Ellen Hodnett, Soo Downe, N Edwards, Denis WalshAbstract:Background: Home-like Birth settings have been established in or near conventional labour wards for the care of pregnant women who prefer and require little or no medical intervention during labour and Birth. Objectives: Primary: to assess the effects of care in a home-like Birth environment compared to care in a conventional labour ward. Secondary: to determine if the effects of Birth settings are influenced by staffing or organizational models or geographical location of the Birth Centre. Search strategy: We searched the Cochrane Pregnancy and ChildBirth Group trials register (18 May 2004) and handsearched eight journals and two published conference proceedings. Selection criteria: All randomized or quasi-randomized controlled trials that compared the effects of a home-like institutional Birth environment to conventional hospital care. Data collection and analysis: Standard methods of the Cochrane Collaboration Pregnancy and ChildBirth Group were used. Two review authors evaluated methodological quality. Double data entry was performed. Results are presented using relative risks and 95% confidence intervals. Main results: Six trials involving 8677 women were included. No trials of freestanding Birth Centres were found. Between 29% and 67% of women allocated to home-like settings were transferred to standard care before or during labour. Allocation to a home-like setting significantly increased the likelihood of: no intrapartum analgesia/anaesthesia (four trials; n = 6703; relative risk (RR) 1.19, 95% confidence interval (CI) 1.01 to 1.40), spontaneous vaginal Birth (five trials; n = 8529; RR 1.03, 95% CI 1.01 to 1.06), vaginal/perineal tears (four trials; n = 8415; RR 1.08, 95% CI 1.03 to 1.13), preference for the same setting the next time (one trial; n = 1230; RR 1.81, 95% CI 1.65 to 1.98), satisfaction with intrapartum care (one trial; n = 2844; RR 1.14, 95% CI 1.07 to 1.21), and breastfeeding initiation (two trials; n = 1431; RR 1.05, 95% CI 1.02 to 1.09) and continuation to six to eight weeks (two trials; n = 1431; RR 1.06, 95% CI 1.02 to 1.10). Allocation to a home-like setting decreased the likelihood of episiotomy (five trials; n = 8529; RR 0.85, 95% CI 0.74 to 0.99). There was a trend towards higher perinatal mortality in the home-like setting (five trials; n = 8529; RR 1.83, 95% CI 0.99 to 3.38). No firm conclusions could be drawn regarding the effects of staffing or organizational models. Authors’ conclusions: When compared to conventional institutional settings, home-like settings for childBirth are associated with modest benefits, including reduced medical interventions and increased maternal satisfaction. Caregivers and clients should be vigilant for signs of complications. Citation: Hodnett ED, Downe S, Edwards N, Walsh D. Home-like versus conventional institutional settings for Birth. The Cochrane Database of Systematic Reviews 2005, Issue 1. Art. No.: CD000012.pub2. DOI: 10.1002/14651858.CD000012.pub2.
-
A Birth Centre's encounters with discourses of childBirth : how resistance led to innovation
Sociology of health & illness, 2007Co-Authors: Denis WalshAbstract:An ethnographic study of a free-standing Birth Centre uncovered a site of intense contestation. Two prominent childBirth discourses attempting to inscribe their orthodoxies on staff and women users encountered stern and persistent resistance. Using postmodern theory, this resistance is conceptualised as nomadic activity, as space is made at the margins of discourse for a difference and diversity to manifest. The relationship between discourse and women's agency is layered and non-linear as the presence of dissonant data indicates. The Birth Centre, however, actualises a number of contrasting ways of 'being' and 'doing' that appear to serve the interests of staff and women well. In particular, 'nomadic' midwifery practice and a 'care as gift' orientation challenges the biomedical model that defines the parameters of normal and the 'vigil of care' discourse that regulates the professional/patient relationship. Birth Centres may encourage novel and eclectic ways of providing childBirth care.
-
nesting and matrescence as distinctive features of a free standing Birth Centre in the uk
Midwifery, 2006Co-Authors: Denis WalshAbstract:Summary Objective to explore the culture, beliefs, values, customs and practices around the Birth process within a free-standing Birth Centre (FSBC). Design ethnography. Setting a Birth Centre situated in the midlands of England. Participants women attending the Centre, midwives and maternity-care assistants (MCAs) working at the Centre. Findings women in the study seemed to invoke intuitive nesting-related behaviours in their assessment of the suitability of the Birth Centre. In addition, the Birth Centre staff's focus on creating the right ambience for Birth may also emanate from nesting concerns. Birth-Centre staff assisted women through the ‘becoming mother' transition, which is conceptualised as ‘matrescent' care. Key conclusions the Birth-Centre environment elicited nesting-like behaviours from both women and staff. This formed part of a nurturing orientation that was conceptualised as ‘matrescent' (becoming mother) care. ‘Matrescence' does not seem to be grounded in clinical skills but is relationally mediated. Implications for practice nesting-like behaviours and ‘matrescent' care in this context challenge maternity services to review traditional conceptualisations of safety and traditional expressions of clinical intrapartum care.
-
subverting the assembly line childBirth in a free standing Birth Centre
Social Science & Medicine, 2006Co-Authors: Denis WalshAbstract:Across the world, concern is being expressed about the rising rates of Birth interventions. As a result, there is growing interest in alternative organisational models of maternity care. Most of the research to date on these models has examined clinical outcomes. This paper, discussing key findings from an ethnographic study of a free-standing Birth Centre in the UK, explores organisational dimensions to care. It suggests that the advantages of scale have been under-recognised by policy makers to date. The Birth Centre displays organisational characteristics that contrast with the dominant Fordist/Taylorist model of large maternity units. These characteristics allow for greater temporal flexibility in labour care and tend to privilege relational, 'being' care over task-orientated, 'doing' care. In addition, features of a bureaucracy are much less in evidence, enabling entrepreneurial activity to flourish. There may be lessons here for other heath services as well as maternity services in optimising the advantages of small-scale provision.
Hannah G Dahlen - One of the best experts on this subject based on the ideXlab platform.
-
mapping the trajectories for women and their babies from Births planned at home in a Birth Centre or in a hospital in new south wales australia between 2000 and 2012
BMC Pregnancy and Childbirth, 2019Co-Authors: Vanessa Scarf, Charlene Thornton, Maralyn Foureur, Hannah G Dahlen, Rosalie Viney, Chris Rossiter, Seong Leang Cheah, Caroline S E HomerAbstract:In New South Wales (NSW) Australia, women at low risk of complications can choose from three Birth settings: home, Birth Centre and hospital. Between 2000 and 2012, around 6.4% of pregnant women planned to give Birth in a Birth Centre (6%) or at home (0.4%) and 93.6% of women planned to Birth in a hospital. A proportion of the woman in the home and Birth Centre groups transferred to hospital. However, their pathways or trajectories are largely unknown. The aim was to map the trajectories and interventions experienced by women and their babies from Births planned at home, in a Birth Centre or in a hospital over a 13-year period in NSW. Using population-based linked datasets from NSW, women at low risk of complications, with singleton pregnancies, gestation 37–41 completed weeks and spontaneous onset of labour were included. We used a decision tree framework to depict the trajectories of these women and estimate the probabilities of the following: giving Birth in their planned setting; being transferred; requiring interventions and neonatal admission to higher level hospital care. The trajectories were analysed by parity. Over a 13-year period, 23% of nulliparous and 0.8% of multiparous women planning a home Birth were transferred to hospital. In the Birth Centre group, 34% of nulliparae and 12% of multiparas were transferred to a hospital. Normal vaginal Birth rates were higher in multiparous women compared to nulliparous women in all settings. Neonatal admission to SCN/NICU was highest in the planned hospital group for nulliparous women (10.1%), 7.1% for nulliparous women planning a Birth Centre Birth and 5.1% of nulliparous women planning a homeBirth. Multiparas had lower admissions to SCN/NICU for all thee settings (hospital 6.3%, BC 3.6%, home 1.6%, respectively). Women who plan to give Birth at home or in a Birth Centre have high rates of vaginal Birth, even when transferred to hospital. Evidence on the trajectories of women who choose to give Birth at home or in Birth Centres will assist the planning, costing and expansion of models of care in NSW.
-
Birthplace in new south wales australia an analysis of perinatal outcomes using routinely collected data
BMC Pregnancy and Childbirth, 2014Co-Authors: Caroline S E Homer, Charlene Thornton, Vanessa Scarf, David Ellwood, Jeremy Oats, Maralyn Foureur, David Sibbritt, Helen L Mclachlan, Della Forster, Hannah G DahlenAbstract:Background: The outcomes for women who give Birth in hospital compared with at home are the subject of ongoing debate. We aimed to determine whether a retrospective linked data study using routinely collected data was a viable means to compare perinatal and maternal outcomes and interventions in labour by planned place of Birth at the onset of labour in one Australian state. Methods: A population-based cohort study was undertaken using routinely collected linked data from the New South Wales Perinatal Data Collection, Admitted Patient Data Collection, Register of Congenital Conditions, Registry of Birth Deaths and Marriages and the Australian Bureau of Statistics. Eight years of data provided a sample size of 258,161 full-term women and their infants. The primary outcome was a composite outcome of neonatal mortality and morbidity as used in the Birthplace in England study. Results: Women who planned to give Birth in a Birth Centre or at home were significantly more likely to have a normal labour and Birth compared with women in the labour ward group. There were no statistically significant differences in stillBirth and early neonatal deaths between the three groups, although we had insufficient statistical power to test reliably for these differences. Conclusion: This study provides information to assist the development and evaluation of different places of Birth across Australia. It is feasible to examine perinatal and maternal outcomes by planned place of Birth using routinely collected linked data, although very large data sets will be required to measure rare outcomes associated with place of Birth in a low risk population, especially in countries like Australia where homeBirth rates are low.
-
Maternal and perinatal outcomes amongst low risk women giving Birth in water compared to six Birth positions on land. A descriptive cross sectional study in a Birth Centre over 12 years.
Midwifery, 2012Co-Authors: Hannah G Dahlen, Helen Dowling, Mark Tracy, Virginia Schmied, Sally K. TracyAbstract:Abstract Background the option of giving Birth in water is available to most women in Birth Centres in Australia but there continues to be resistance in mainstream delivery wards due to safety concerns. Women in Birth Centres are more likely to give Birth in upright positions and be attended by experienced midwives and obstetricians who are comfortable facilitating normal Birth. The aim of this study was to determine rates of perineal trauma, postpartum haemorrhage and five-minute Apgar scores amongst low risk women in a Birth Centre who gave Birth in water compared to six Birth positions on land. Methods this was a descriptive cross sectional study of Births occurring in a large alongside Sydney Birth Centre from January 1996 to April 2008. Handwritten records were kept by midwives on each Birth in the Birth Centre over twelve and a half years ( n =6,144). Descriptive statistics and logistic regression were applied controlling for risk factors for perineal trauma, postpartum haemorrhage and the five-minute Apgar score. Findings waterBirth (13%) and six main Birth positions on land were identified: kneeling/all fours (48%), semi-recumbent (12%), lateral (5%), standing (8%), Birth stool (10%) and squatting (3%). Compared to waterBirth, Birth on a Birth stool led to a higher rate of major perineal trauma (second, third, fourth degree tear and episiotomy) (OR 1.40 [1.12–1.75]) and postpartum haemorrhage (OR 2.04 [1.44–2.90]). Compared to waterBirth, babies born in a semi-recumbent position had a significantly greater incidence of five-minute Apgar scores Conclusions waterBirth does not lead to more infants born with Apgar score