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Cochrane Database Syst Rev. 2000;(2):CD000012.

Home-like versus conventional institutional settings for birth.

Author information

  • Maternal, Infant and Reproductive Health Research Unit, 790 Bay Street, Sute 715, Toronto, Ontario, CANADA, M5G 1N8. ellen.hodnett@utoronto.ca

Abstract

BACKGROUND:

Many home-like birth centres have been established near conventional labour wards for the care of pregnant women who prefer and require little or no medical intervention during labour and birth.

OBJECTIVES:

The objective of this review was to assess the effects of care in a home-like birth environment compared to care in a conventional labour ward, on labour and birth outcomes.

SEARCH STRATEGY:

The Cochrane Pregnancy and Childbirth Group trials register was searched.

SELECTION CRITERIA:

Randomised and quasi-randomised trials comparing a home-like institutional birth environment to conventional hospital care for pregnant women at low risk of obstetric complications.

DATA COLLECTION AND ANALYSIS:

Trial quality was assessed.

MAIN RESULTS:

Five trials involving almost 8000 women were included. Substantial numbers of women allocated to home-like settings were transferred to standard care before or during labour, making interpretation of results difficult. Allocation to a home-like setting was associated with lower rates of intrapartum analgesia/anaesthesia (odds ratio 0.82, 95% confidence interval 0.72 to 0.93), fetal heart rate abnormalities (0.72, 95% confidence interval 0.63 to 0.81), augmented labour, and immobility during labour, as well as greater satisfaction with care, and increased likelihood of sore nipples and mastitis. There was a non-statistically significant trend towards higher perinatal mortality in the home-like setting (odds ratio 1.49, 95% confidence interval 0.79 to 2.78).

REVIEWER'S CONCLUSIONS:

There appear to be some benefits from home-like settings for childbirth, although increased support from caregivers may be more important. Caregivers and clients in home-like settings need to watch for signs of complications.

PMID:
10796083
[PubMed - indexed for MEDLINE]
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