The Dutch presentation about its high infant mortality at the peristat meeting in June focussed on the high rate of congenital anomalies and said what was being done about that, Dutch policies about resuscitation of very preterm babies and the high age of mothers at childbirth, the highest in Europe. Obviously no one can turn the clock back, but they want to address maternity leave and child care problems with a view to enabling women to have babies younger in future.
Obviously, the moment the Dutch obstetrician who gave this talk stood up to give it, every other obstetrician in the room was expecting him to say something about home births. When questioned, he said that no, that wasn't what gaive the Netherlands a high infant mortality rate, it was the other things he had spoken about.
Alison
Alison Macfarlane
Department of Midwifery
City University
24 Chiswell Street
London EC1Y 4TY
Phone (0) (44) 207 040 5832
Fax (0) (44) 207 040 5866
Email [log in to unmask]
-----Original Message-----
From: A forum for discussion on midwifery and reproductive health research. [mailto:[log in to unmask]] On Behalf Of Elizabeth Duff
Sent: 22 September 2006 08:45
To: [log in to unmask]
Subject: Re: Safety of births outside conventional maternity settings
With regard to the mention of the Dutch perinatal death rate, I have understood from conversation with Dutch midwives that this rate is likely always to be somewhat higher than, e.g. the UK one, since policies on both antenatal screening for abnormality and neonatal intensive care for extremely premature infants are substantially different, leading - in the Netherlands - to fewer terminations of pregnancy for abnormality and fewer very preterm babies surviving. These approaches to care, I believe, are not connected with home, hospital or birth centre settings.
Dutch midwives please correct me if I am wrong as this is anecdotal.
Elizabeth (non-midwife, non-researcher, non-Dutch!)
----- Original Message -----
From: "Soo Downe" <[log in to unmask]>
To: "(Elizabeth Duff)" <[log in to unmask]>
Sent: Thursday, September 21, 2006 11:06 PM
Subject: Re: Safety of births outside conventional maternity settings
Dear Sophie
I agree with Declan, Jane, and Alison that it is important to be clear
what is being compared with what. There are at least the following
configurations, and evidence from one type of configuration will not
necessary apply to the others, quite apart from the separate question
about the transferability across cultures:
home births with publicly paid midwives or nurse-midwives
home births with publicly paid doctors
home births with independent, private midwives or doctors
centralised hospitals without midwife led care
centralised hospitals with midwife led care
birth centres based within a centralised hospital without midwife led
care
birth centres based within a centralised hospital with midwife led
care
Birth centres geographically separate from centralised hospitals
without midwife led care
Birth centres geographically separate from centralised hospitals with
midwife led care
Then there is the issue of selection criteria, as raised in Alisons
letter - if a system accepts high risk births, the mortality rates
cannot be generalised to systems that accept low risk birth. And, of
course, the findings must be based on intention to treat, otherwise they
are not useful for policy development. To me, these are the kind of
arguments that can be used to counter claims that, for example, data on
home birth undertaken by private independent midwives can be applied to
integrate birth centres.
For data on integrated birth centres based within centralised units,
the relevant Cochrane review is probably the best evidence:
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
Summarised in: Hodnett ED, Downe S, Edwards N, Walsh D. 2005 Home-like
versus conventional institutional settings for birth. Birth, 32 (2)
151-151(1)
In the review, we do note a possible trend towards increased perinatal
mortality, but this does not reach statistical significance, even though
we included 8677 women. This suggests that the risk, if it does exist
and can be generalisible, is very much lower than 1:70 in these
settings. We also hypothesise that the issues underlying this may be
about disarticulation between systems - the consequence of this is that
in systems where there is good mutual trust and respect between those
working in the birth centre and those working in the hospital system, it
may be that perinatal risk is minimised. This theory still needs to be
tested.
The only review I am aware of that is focused on free standing
(geographically separate) units that I am aware of, apart from the very
comprehensive NPEU report, is our paper in Birth:
Walsh D, Downe S 2004 Outcomes of Free-Standing, Midwifery-Led Birth
Centres: a structured review. Birth 31:3 222-9
This concludes that the evidence base is not good, but such data as we
do have indicates that there may be many benefits for women and babies
booking for birth in these kind of settings.
Finally, it is true that we don't have a robust evidence base for any
birth setting except alongside, integrated birth centres: importantly,
this means that we don't have good data for hospital centralised
obstetrician led units, but I don't see governments or policy makers
trying to close them, or arguing that we don't have good evidence to
keep them open!.
I really think it is time for an RCT in this area. If anyone is
interested in discussing collaboration in a feasibility study that a
group of collaborators are currently planning, please let me know.
All the best
Soo
Professor Soo Downe
Director
Midwifery Studies Research Unit
University of Central Lancashire
Preston PR1 2HE
Lancashire
England
+44 (0) 1772 893815
tel: 01772 893815
>>> Sophie Alexander <[log in to unmask]> 21/09/2006 15:37:55 >>>
The government has asked both our Belgian academies of medicine to
examine
the question of birth centres. The
report written by the French
speaking
branch of the Belgian academy of medicine is using in its (negative)
conclusion the data from an Irish paper which reports a 1/70 death rate
for
midwife booked home deliveries. The paper is attach. I would be
grateful
for any useful information which would help me to counterbalance this
information.
We know of course that in Holland home births are not leading to a
1:70
death rate, but the Dutch perinatal death rate is high when compared to
its
neighbouring countries, and also, there have been suggestions that
asphyxia,
and even post asphyxic sequellae were more prevalent in the Netherlands
in
home births than institutional births.
We also have accessed the report on birth centres commissioned by NPEU
in
Oxford, but it does not give strong argumentation to disqualify the
Irish
paper.
I was just wondering whether there might be some major, non obvious
flaw in
the Irish data? Or if someone "out there" had a really strong
argument for
me?
Many thanks
Sophie Alexander, MD, PhD
Perinatal Epidemiology and Reproductive health Unit
School of Public Health CP 597
Université Libre de Bruxelles
808, Route de Lennik
1070 Brussels
Belgium
Tel +32 (0)2 555 4063 or 4079
Fax +32 (0)2 555 4049
_____
De : European Perinatal Epidemiology Network
[mailto:[log in to unmask]] De la part de Jane
Sandall
Envoyé : jeudi 21 septembre 2006 12:09
À : [log in to unmask]
Objet : Members wanted for the ICM Research Advisors Network
The International Confederation of Midwives' Research Standing
Committee is
looking to expand the network of research advisors/peer reviewers.
This
multi-disciplinary network serves the dual function of facilitating
research
collaboration among members as well as providing expertise and advice
to the
ICM and the Research Standing Committee o-n research issues. In
addition,
this network will be asked to peer review research abstracts for the
next
ICM Triennial Conference in Glasgow in 2008. We currently have over
100
members from 16 different countries and would particularly welcome
members
from resource poor regions.
We are looking to expand this network for people from a range of
disciplines
who have any one of the following:
·* PhD or research doctorate
·* Peer reviewed research publications
·* Track record of research in women's health/maternity care
We have published a contact database of members' research expertise o-n
the
ICM website to facilitate networking among members.
To see our member's database go to
http://www.internationalmidwives.org/index.php?module=pnAdvisory
We would be pleased to hear from any person who believes s/he can
contribute
to the process of providing research advice and reviewing research. In
accordance with other networks of this type, applicants will be asked
to
complete an application before acceptance. This application is
available at
the following web link:
http://www.internationalmidwives.org/index.php?module=ContentExpress
<http://www.internationalmidwives.org/index.php?module=ContentExpress&func=d
isplay&ceid=28&bid=30&btitle=ICM%20Activities&meid=22>
&func=display&ceid=28&bid=30&btitle=ICM%20Activities&meid=22
Please send the application directly to Della Forster, RSC Networking
Chair
at <mailto:[log in to unmask]> [log in to unmask] If you
have
any queries, please contact me directly at the address below.
Della Forster
ICM Research Standing Committee Networking Chair
[log in to unmask]
ICM Headquarters, Eisenhowerlaan 138, 2517 KN, The Hague, The
Netherlands.
Tel: +31 70 3060520 Fax: +31 70 3555651
http://www.internationalmidwives.org
<http://www.internationalmidwives.org/index.php?module=ContentExpress&func=d
isplay&ceid=28&bid=30&btitle=ICM%20Activities&meid=22>
Dr Jane Sandall
Professor of
Midwifery and Women's Health
Health and Social Care Research Division
King's College, London.
Waterloo Bridge Wing,
150 Stamford Street,
London, SE1 9NH
Tel: 020 7848 3605
Fax: 020 7848 3764
e-mail:[log in to unmask]
http://www.kcl.ac.uk/schools/medicine/research/hscr/sandall.html
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