Alternative versus conventional institutional settings for birth

Background: Alternative institutional settings have been established for the care of pregnant women who prefer and require little or no medical intervention. The settings may offer care throughout pregnancy and birth, or only during labour; they may be part of hospitals or freestanding entities. Specially designed labour rooms include bedroom-like rooms, ambient rooms, and Snoezelen rooms. Objectives: Primary: to assess the effects of care in an alternative institutional birth environment compared to care in a conventional institutional setting. Secondary: to determine if the effects of birth settings are influenced by staffing, architectural features, organizational models or geographical location. Search strategy: We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (31 May 2010). Selection criteria: All randomized or quasi-randomized controlled trials which compared the effects of an alternative institutional maternity care setting to conventional hospital care. Data collection and analysis: We used standard methods of the Cochrane Collaboration Pregnancy and Childbirth Group. Two review authors evaluated methodological quality. We performed double data entry and have presented results using risk ratios (RR) and 95% confidence intervals (CI). Main results: Nine trials involving 10684 women met the inclusion criteria. We found no trials of freestanding birth centres or Snoezelen rooms. Allocation to an alternative setting increased the likelihood of: no intrapartum analgesia/anaesthesia (five trials, n = 7842; RR 1.17, 95% CI 1.01 to 1.35); spontaneous vaginal birth (eight trials; n = 10,218; RR 1.04, 95% CI 1.02 to 1.06); breastfeeding at six to eight weeks (one trial, n = 1147; RR 1.04, 95% CI 1.02 to 1.06); and very positive views of care (two trials, n = 1207; RR 1.96, 95% CI 1.78 to 2.15). Allocation to an alternative setting decreased the likelihood of epidural analgesia (seven trials, n = 9820; RR 0.82, 95% CI 0.75 to 0.89); oxytocin augmentation of labour (seven trials, n = 10,020; RR 0.78, 95% CI 0.66 to 0.91); and episiotomy (seven trials, n = 9944; RR 0.83, 95% CI 0.77 to 0.90). There was no apparent effect on serious perinatal or maternal morbidity/mortality, other adverse neonatal outcomes, or postpartum hemorrhage. No firm conclusions could be drawn regarding the effects of variations in staffing, organizational models, or architectural characteristics of the alternative settings. Authors' conclusions: When compared to conventional settings, hospital-based alternative birth settings are associated with increased likelihood of spontaneous vaginal birth, reduced medical interventions and increased maternal satisfactio

Effect on birth outcomes of a formalised approach to care in hospital labour assessment units: international, randomised controlled trial

Objective To determine if a complex nursing and midwifery intervention in hospital labour assessment units would increase the likelihood of spontaneous vaginal birth and improve other maternal and neonatal outcomes

Antenatal care packages with reduced visits and perinatal mortality: a secondary analysis of the WHO antenatal care trial - Comentary: routine antenatal visits for healthy pregnant women do make a difference

Abstract The practice and timing of routine antenatal visits for healthy pregnant women, introduced arbitrarily and without evidence of effectiveness, have become entrenched in obstetric practice over the last century. In 2001 the large, cluster randomized WHO Antenatal Care Trial concluded that a goal-orientated package of antenatal care with reduced visits seemed not to affect maternal and perinatal outcomes. The reduced visit package has been implemented in several countries. The current re-analysis finds that the significantly increased perinatal mortality which occurred in the reduced visit package persists after adjustment for potential confounding factors. The WHO Antenatal Care Trial provided the first evidence from a randomized trial that the traditional high frequency of routine visits in the third trimester may well reduce perinatal mortality

External cephalic version beginning at 34 weeks' gestation versus 37 weeks' gestation: A randomized multicenter trial

Caroline Crowther is listed as a member of the Early External Cephalic Version Trial Grouphttp://www.elsevier.com/wps/find/journaldescription.cws_home/623277/description#descriptio

Cohort profile:The promotion of breastfeeding intervention trial (PROBIT)

SummaryThe PROmotion of Breastfeeding Intervention Trial (PROBIT) is a multicentre, cluster-randomized controlled trial conducted in the Republic of Belarus, in which the experimental intervention was the promotion of increased breastfeeding duration and exclusivity, modelled on the Baby-friendly hospital initiative. Between June 1996 and December 1997, 17 046 mother–infant pairs were recruited during their postpartum hospital stay from 31 maternity hospitals, of which 16 hospitals and their affiliated polyclinics had been randomly assigned to the arm of PROBIT investigating the promotion of breastfeeding and 15 had been assigned to the control arm, in which breastfeeding practices and policies in effect at the time of randomization was continued. Of the mother–infant pairs originally recruited for the study, 16 492 (96.7%) were followed at regular intervals until the infants were 12 months of age (PROBIT I) for the outcomes of breastfeeding duration and exclusivity; gastrointestinal and respiratory infections; and atopic eczema. Subsequently, 13 889 (81.5%) of the children from these mother–infant pairs were followed-up at age 6.5 years (PROBIT II) for anthropometry, blood pressure (BP), behaviour, dental health, cognitive function, asthma and atopy outcomes, and 13 879 (81.4%) children were followed to the age of 11.5 years (PROBIT III) for anthropometry, body composition, BP, and the measurement of fasted glucose, insulin, adiponectin, insulin-like growth factor-I, and apolipoproteins. The trial registration number for Current Controlled Trials is ISRCTN37687716 and that for ClinicalTrials.gov is NCT01561612. Proposals for collaboration are welcome, and enquires about PROBIT should be made to an executive group of the study steering committee (M.S.K., R.M.M., and E.O.). More information, including information about how to access the trial data, data collection documents, and bibliography, is available at the trial website (http://www.bristol.ac.uk/social-community-medicine/projects/probit/)

Outcomes at 3 Months After Planned Cesarean vs Planned Vaginal Delivery for Breech Presentation at Term

Caroline Crowther is listed as a member of the Term Breech Trial 3-Month Follow-up Collaborative Group in the article.Mary E. Hannah; Walter J. Hannah; Ellen D. Hodnett; Beverley Chalmers; Rose Kung; Andrew Willan; Kofi Amankwah; Mary Cheng; Michael Helewa; Sheila Hewson; Saroj Saigal; Hilary Whyte; Amiram Gafni; for the Term Breech Trial 3-Month Follow-up Collaborative Grou

Mothers' Views ofTheir Childbirth Experiences 2 Years Mter Planned Caesarean Versus Planned Vaginal Birth for Breech Presentation at Term, in the International Randomized Term Breech Trial

Objective: To compare mothers' views at 2 years postpartum after participation in a randomized trial of planned Caesarean and planned vaginal birth for a singleton fetus in breech presentation at term.Study Design: In selected centres in the Term Breech Trial, mothers completed a structured questionnaire at approximately 2 years postpartum to assess their likes and dislikes about their childbirth experiences and their views about their intrapartum care and care providers.Results: Of 1159 mothers from 85 centres, 917 (79.1%) completed a follow-up questionnaire at 2 years postpartum. Baseline information was similar for both the planned Caesarean and planned vaginal birth groups. Planned Caesarean was associated with less worry about the baby's health (P < 0.001 ). While other differences were noted in likes and dislikes about their childbirth experiences, women's evaluations of the quality of intrapartum care, the helpfulness of staff, and their involvement in decision-making did not differ in the planned Caesarean delivery and planned vaginal birth groups.Conclusion: Planned mode of delivery influences aspects of women's evaluations of their childbirth experiences but does not affect evaluations of the quality of intrapartum care, support from care providers, or amount of involvement in decision-making

Outcomes of children at 2 years after planned cesarean birth versus planned vaginal birth for breech presentation at term: The international randomized Term Breech Trial.

Caroline Crowther is listed as a contributor to the 2 year infant follow-up Term Breech Trial Collaborative GroupHilary Whyte, Mary E. Hannah, Saroj Saigal, Walter J. Hannah, Sheila Hewson, Kofi Amankwah, Mary Cheng, Amiram Gafni, Patricia Guselle, Michael Helewa, Ellen D. Hodnett, Eileen Hutton, Rose Kung, Darren McKay, Susan Ross, Andrew Willan, for the 2-year infant follow-up Term Breech Trial Collaborative Grouphttp://www.elsevier.com/wps/find/journaldescription.cws_home/623277/description#descriptio

Maternal outcomes at 2 years after planned cesarean section versus planned vaginal birth for breech presentation at term: The international randomized Term Breech Trial

Caroline Crowther is a contributor to the 2-year maternal follow-up Term Breech Trial Collaborative GroupMary E. Hannah, Hilary Whyte, Walter J. Hannah, Sheila Hewson, Kofi Amankwah, Mary Cheng, Amiram Gafni, Patricia Guselle, Michael Helewa, Ellen D. Hodnett, Eileen Hutton, Rose Kung, Darren McKay, Susan Ross, Saroj Saigal, Andrew Willan, for the 2-year maternal follow-up Term Breech Trial Collaborative Grou