appendix i: evidence tables - nice

NICE Guideline Templatesettings? .................................................................................................... 3
settings? HEALTH ECONOMICS ........................................................... 306
1.1.3 Women’s experiences and views of different birth settings .................... 313
1.1.4 What is the appropriate staffing configuration of midwives and
healthcare support staff on labour ward to support one-to-one
continuous care during labour? .............................................................. 394
1.1.5 Care in the latent phase (services) ......................................................... 415
1.1.6 Care in the latent phase (pain) ............................................................... 449
1.1.7 What is the effectiveness of continuous electronic fetal monitoring
compared with intermittent auscultation ON ADMISSION? .................... 474
compared with intermittent auscultation DURING ESTABLISHED
LABOUR? .............................................................................................. 488
compared with intermittent auscultation when there is meconium-
stained liquor? ....................................................................................... 519
1.1.10 What are the appropriate definitions and interpretation of the features
of an electronic fetal heart rate (FHR) trace? ......................................... 522
1.1.11 Does the use of fetal scalp stimulation as an adjunct to electronic fetal
monitoring improve the predictive value of monitoring and clinical
outcomes when compared to: a) EFM alone, b) EFM plus ECG ............ 625
1.1.12 Does the use of fetal blood sampling as an adjunct to electronic fetal
monitoring (EFM) improve outcomes, when compared to a) EFM alone;
b) EFM plus ECG (including ST analysis)? ............................................ 677
1.1.13 What is the time from the decision to perform a fetal blood sample to
having the blood result? ......................................................................... 701
1.1.14 What is the predictive value of the following measures, for maternal
and neonatal outcomes: fetal blood pH analysis, fetal blood lactate
analysis, fetal acid-base status, and fetal-base deficit? .......................... 704
1.1.15 What is the effectiveness of cardiotocography using telemetry
compared with conventional cardiotocography? ..................................... 762
1.1.16 What are women's views and experiences of fetal monitoring in labour? 796
Update information February 2017: Sections that have been updated (see addendum files) have been marked with dark grey shading’
Intrapartum care (update) appendices
1.1.17 Does the use of fetal electrocardiogram (ECG) analysis with
continuous electronic fetal monitoring (EFM) improve outcomes when
compared with continuous EFM alone? ................................................. 816
1.1.18 What is the effectiveness of different methods of intrauterine
resuscitation for babies with and without meconium-stained liquor? ....... 826
1.1.19 What is the intra-rater and inter-rater reliability of scoring systems for
meconium-stained liquor? What is the effectiveness of scoring/grading
systems for improving neonatal and maternal outcomes when there is
meconium stained liquor? ...................................................................... 891
1.1.20 When the need to intervene to expedite birth has been identified, what
is the appropriate decision to delivery interval for a vaginal birth? .......... 900
1.1.21 Is active management of the third stage of labour more effective than
physiological management? ................................................................... 927
1.1.22 Does early cord clamping in active management of the third stage of
labour improve maternal and neonatal outcomes compared to late or
delayed cord clamping? ......................................................................... 951
1.1.23 Is oxytocin 10 IU im the most effective drug/route/dose to use in the
active management of the third stage of labour? .................................... 983
1.1.24 What is the most effective management of retained placenta in women
who have had active management of the third stage of labour: a) with
PPH b) without PPH ............................................................................. 1000
1.1.25 What are the most effective interventions in managing primary PPH
(arresting bleeding) due to uterine atony including: a) medical
interventions ........................................................................................ 1051
1.1.26 What are the most effective SURGICAL interventions in managing
primary PPH (arresting bleeding) due to uterine atony? ....................... 1086
1.1.27 Is air more effective than oxygen when used for neonatal resuscitation
(a) initially and (b) after a period of no/poor response? ........................ 1093
1.1.28 Is routine paired blood gas analysis predictive of perinatal or longer
term outcome? ..................................................................................... 1123
1.1.29 What is the appropriate care of babies born with meconium-stained
liquor? .................................................................................................. 1156
1.1.1 Maternal and neonatal outcomes associated with different birth settings?
Study details Participants Interventions Methods
Outcomes and
Results Comments
Full citation
Blix,E., Huitfeldt,A.S.,
Oian,P., Straume,B.,
retrospective cohort study,
Sexual and Reproductive
Healthcare, 3, 147-153,
presentations.
Planned home births = 1,631
(1.3) / 168 (2.5) / 7 (0.6) / 156
(1.7)
0 / 30 (2.4) / 0
Women who planned home
Interventions
midwives who had
gave the
Number who did not
for results. No description
environments.
Outcomes and
Results Comments
inclusion criteria.
imputations was judged
to be sufficient).
/ na / 1182 / na
- 30.04
Interventions
of birth-place on PPH.
Outcomes and
Results Comments
comparing third stage
postpartum haemorrhage
stage of labour.
Secondary hospital: n = 7,380
/ Tertiary hospital: n = 4,123
Inclusion criteria
Low risk
Exclusion criteria
and analysed on an
Outcomes and
Results Comments
Not stated
Full citation
planned home versus
onset of labour) with
maternal morbidity than
602 (58.1); planned hospital
66,554 (72.1); planned
some registration data was
misclassified.
two year period meaning
relatively difficult previous
birth next time causing
Other information
Outcomes and
Results Comments
compare the rate of
from ZonMw. It was
no role in any aspect of the
study.
study and the
labour
= 18,070).
PPH (n = 1,248)
potential confounders.
all variables.
Full citation
Interventions
Women in the TLW
TLW group desired to be
admitted to the HLBC.
Outcomes and
Results Comments
"Home-like birth centre"
the HLBC or TLW with no
complications.
best predictive model.
minutes and the
Outcomes and
Results Comments
variance, as needed.
Wilcoxon test, as
Outcomes and
Results Comments
observational study of over
500,000 maternities in the
UK, BMC Pregnancy and
Childbirth, 12, 130-, 2012
Sample size
n = 273,872
to 40+
Inclusion criteria
Inclusions: n = 273,872
locations. Statistical
finished twelve years
birth) and based on old
data.
Outcomes and
Results Comments
population (i.e. not just
reference hospitals (in
Results
for confounders
matched pairs analysis.
were taller but not in the
matched pairs. Overall
(total study population),
employed, but this is not
reported for the matched
Outcomes and
Results Comments
Source of funding
Swiss National Science
449]
= 352]
183]
= 183]
did not conform with
study criteria, and 6
reported. Study
populations were
matched by:
are reported
excluding women with CS,
but subtracting that from
denominator does not give
reported %. 7 women had
Precise definition of
Outcomes and
Results Comments
p = 0.42
Matched pairs
(%))*
possible to detect a
to assess more
frequent outcomes like
women had vaginal
had hypertension
post-term (> 293 days)
< 0.001)
differences were significant
the 2007 guideline]
Outcomes and
Results Comments
p = 0.53
Matched pairs
Inclusion criteria
in hospital (recorded during
decision was taken)
(CS).
forms, and their data
same way. Records of
both hospital and home
births were coded by
obstetrician, and then
specially trained
paediatricians. The
mothers completed
three questionnaires:
as per the other
restricted to the
Outcomes and
Results Comments
discordant pairs.
Outcomes reported
CS and rate of
Outcomes and
Results Comments
3. Vaginal/perineal
were transferred to
hospital for postnatal
Outcomes and
Results Comments
Maguire,R., Higgins,S.,
Finan,A., Gormally,S.,
complications in the
delivery
Characteristics
the two units, one
for the first seven
and 3 CLU women were
incomplete because they
moved during pregnancy
Outcomes and
Results Comments
Study dates
Source of funding
birth
BMI < 18 or > 29
per day
Latex allergy
study are reported here.
women receiving public
booking clinic, women
study. (note: this was
447 from the other)
RR 1.03 (95% CI
through the trial.
Indirectness: 22.5% of
CLU arm experienced
induction of labour
guideline]
complication requiring an
Outcomes and
Results Comments
34 weeks gestation
- postpartum haemorrhage (>
the grounds of making
new MLU.
Randomisation was
were used, stratified by
study centre with a
separated list for each
centre and by random
their allocated intervention
follow-up or had their
CLU arm (n = 552)
their allocated intervention
follow-up or had their
Outcomes and
Results Comments
- uterine fibroids
- cervical cerclage
possible for this study.
Access to MLU was
only through the trial.
same small group of
24 weeks
MLU: 17/1101
weeks
Outcomes and
Results Comments
other). Antenatal
the woman's GP.
the criteria below. After
postnatal. After
MLU and 3.66 per
1000 in the CLU.
Causes of death are
Outcomes and
Results Comments
discharge, midwives
Outcomes and
Results Comments
established labour
Outcomes and
Results Comments
occasions at least 1
(absent or slower
cervical dilatation than
0.5 cm/hour for
primigravidae and 1
Outcomes and
Results Comments
- Retained placenta (>
1 hour)
Outcomes and
Results Comments
occasions at least 1
Outcomes and
Results Comments
80% power to detect
differences of at least
6% in the various
continuous electronic
fetal monitoring,
initiation of
Outcomes and
Results Comments
stopping alpha was
Outcomes and
Results Comments
randomised controlled trial,
BJOG : an international
differences in operative
alongside, midwifery-led unit
those numbers
Education (n/total (%))
Primary school
the meta-analysis
Other information
Comparison: ALONGSIDE
Outcomes and
Results Comments
clear when the study started
Source of funding
extended surveillance
but only low risk women
are accepted at the
MLU. Each unit has
guideline]
complications, but
proportion.
Outcomes and
Results Comments
influence the pregnancy
Recruitment and
women planning to give
in the Hospital when
they were being called
for ultrasound. At the
eligible and consented,
she was recruited.
inclusion criteria at the
participate.
meet the inclusion
Outcomes and
Results Comments
uterus
weeks of gestation
onset of spontaneous
to pre-eclampsia,
placenta praevia,
intrauterine growth
restriction, breech
Outcomes and
Results Comments
extended needs,
the electronic journal
system of the
department, as is
not work at any of the
three units.
Outcomes and
Results Comments
0.05, 1642 women were
the reference standard.
The statistician was
blinded to allocation.
Analysis was by
retained placenta
given
Vaginal/perineal
Outcomes and
Results Comments
Outcomes and
Results Comments
Outcomes and
Results Comments
Outcomes and
Results Comments
with low risk pregnancies:
the Birthplace in England
in labour. They were
included in this group
even if they were
units.
for these confounders
Groups comparable at
baseline: No, women
economically advantaged
between the home and
Outcomes and
Results Comments
care in labour for women
with low risk pregnancies
(funded by the Department
of Health Policy Research
collection forms were
Groups received
specific details are given
for confounders; however,
outcome data, less than
1% have missing data
Outcomes and
Results Comments
(n (%))
forms were completed
by midwives (assisted
Home: 5.4%; Fr-MLU:
5.5%; Al-MLU: 6.9%)
2007 guideline]
Puddicombe D, Rowe R,
national prospective cohort
study: perinatal and
maternal outcomes by
Delivery and Organisation
Outcomes and
Results Comments
18.5 - 24.9
clustered nature of the
varying probability of a
interaction between
parity generated the
following p-values for
parity adjusted regression
tests of heterogeneity:
interaction between
parity generated the
following p-values for
parity adjusted regression
tests of heterogeneity:
Outcomes and
Results Comments
all analyses.
Subgroup analyses
A pre-specified
test for statistical
was also done.
least 85% of eligible
not powered for these
Outcomes and
Results Comments
labour (19.5% in OU
settings), further
agreed before the start
early neonatal death,
Outcomes and
Results Comments
weight was compared with
growth reference centiles, and
for the gestational age and >
5th centile for a gestation of 37
weeks, the birth was assumed
to be term but the gestation
was recoded as 'missing'. A
gestation of > 44 weeks was
considered implausible and
neonatal unit within 48
48 hours with evidence of
feeding difficulties or
Outcomes and
Results Comments
labour (n (%))
Outcomes and
Results Comments
neonatal unit within 48
48 hours with evidence of
feeding difficulties or
Outcomes and
Results Comments
to 3.16)
to 3.39)
to 2.24)
Multiparous women
OU: 6737/7429
Outcomes and
Results Comments
to 8.74)
to 7.60)
to 4.12)
0.56)
Outcomes and
Results Comments
to 0.21)
to 0.22)
to 0.62)
Outcomes and
Results Comments
OU: 17097 (88.2)
Home: 16056 (96.0)
Fr-MLU: 10444 (93.6)
Al-MLU: 15014 (91.2)
to 0.76)
to 0.74)
to 0.35)
to 0.61)
to 1.11)
Outcomes and
Results Comments
Al-MLU: 243
to 0.71)
to 0.62)
to 0.73)
Multiparous women
OU: 294/7429
Home: 65/11338
Fr-MLU: 38/5714
Al-MLU: 70/7629
- Adjusted OR
OU: 1
Outcomes and
Results Comments
place of birth (for any amount
of time)
pregnancies (i.e. before the
medical or obstetric risk
guideline Intrapartum Care)
to 0.31)
to 0.41)
to 0.49)
to 0.46)
to 0.66)
Outcomes and
Results Comments
care in labour
OU: 48/15676 (3.1
[2.2 to 4.2])
to 0.20)
to 0.27)
to 0.47)
Outcomes and
Results Comments
to 0.60)
to 0.24)
to 0.39)
to 0.62)
Outcomes and
Results Comments
- Adjusted OR:
OU: 1.00
to 1.21)
to 1.24)
to 0.95)
Outcomes and
Results Comments
- Unadjusted OR:
OU: 1.00
to 1.26)
to 0.82)
to 1.18)
Multiparous women
OU: 48/7386
Home: 44/11256
Fr-MLU: 24/5678
Al-MLU: 42/7575
Outcomes and
Results Comments
women without
to 1.19)
to 1.12)
to 1.77)
to 1.28)
to1.09)
to 1.36)
Outcomes and
Results Comments
to 1.11)
to 1.14)
to 1.36)
Outcomes and
Results Comments
- Unadjusted OR:
OU: 1.00
Outcomes and
Results Comments
Outcomes and
Results Comments
- Adjusted OR
OU: 1
Outcomes and
Results Comments
Al-MLU: 6357/8336
Outcomes and
Results Comments
Al-MLU: 8025/8317
Outcomes and
Results Comments
Outcomes and
Results Comments
Home: 50/12244
Outcomes and
Results Comments
Nulliparous women
OU: 1204/10617
Outcomes and
Results Comments
Multiparous women
Outcomes and
Results Comments
Forceps (n/total (%
[99% CI])
Nulliparous women
OU: 1125/10617
Outcomes and
Results Comments
to 1.10)
Multiparous women
Outcomes and
Results Comments
to 1.04)
Intrapartum CS
Outcomes and
Results Comments
to 0.50)
Outcomes and
Results Comments
to 0.23)
Outcomes and
Results Comments
Outcomes and
Results Comments
Outcomes and
Results Comments
Outcomes and
Results Comments
to 0.87)
Outcomes and
Results Comments
Outcomes and
Results Comments
Outcomes and
Results Comments
Outcomes and
Results Comments
OU: 1
Outcomes and
Results Comments
Outcomes and
Results Comments
Outcomes and
Results Comments
Outcomes and
Results Comments
b. Nulliparous
Outcomes and
Results Comments
Home: 2057/4568
Outcomes and
Results Comments
Home: 51/12256
Outcomes and
Results Comments
- Nulliparous: 5187
- Multiparous: 6078
Al-MLU: 16710
- Nulliparous: 8350
- Multiparous: 8323
Most common
setting, as a
Outcomes and
Results Comments
Meconium staining
Outcomes and
Results Comments
Fetal distress
Outcomes and
Results Comments
Outcomes and
Results Comments
Outcomes and
Results Comments
Outcomes and
Results Comments
Outcomes and
Results Comments
moved are not reported)
conventional delivery
Outcomes and
Results Comments
Ref Id
process would increase
effective than conventional
Source of funding
Queen Victoria Foundation
ked) birth in
and shower. All medical
their pregnancy, and
were eligible for
randomisation from 20
clerical officer not
0.90 to 1.26)
Unclear
delivery suite arm,
not reported
Intention-to-treat analysis
performed: Yes
arm had induction of
breech presentation.
Outcomes and
Results Comments
Commonwealth Department
sequence of sealed
midwife committed to
reported that 56% of
had external monitor and
electrode, but this may
have been after transfer.
the 2007 guideline]
Outcomes and
Results Comments
hours.
doctor, the former being
the main care-giver who
liaised with the latter.
needs of each woman,
Outcomes and
Results Comments
the discretion of the
difference in episiotomy
sample size was not
Outcomes and
Results Comments
trial, and outcome data
from case notes and
at six weeks
Outcomes and
Results Comments
Hempsall,V., Hatchard,K.,
Bournemouth Hospital,
care given to women
midwife-led maternity unit
a consultant obstetric unit
June 1993
obstetric unit
Parity (n (%))
hospital, there
c. Caesarean
unrelated to confounders
(selection bias): Unclear:
control for baseline risk
to book earlier compared
OU
miscarriage/abortion/intrau
women who had multiple
and 703 in the OU arm.
For the outcome of blood
Outcomes and
Results Comments
clients at the centre of
decision making,
'normal physiological
Blood loss over 500
outcomes: Yes, except
'significant problems after
37 weeks; 56/1480 (3.8%)
of babies were non
risk inclusion criteria at
reported what their risk
labour.
Outcomes and
Results Comments
OU: 15.3 [n = 688]
- Consultant led: 15.5 [n =
(Note: it was not stated for 13
women in the MLU arm and 17
women in the OU arm)
Inclusion criteria
or the general hospital during
the study period
page of the
master list of everyone
who fulfilled criteria for
booking at the MLU.
The rest of the
and in 35 cases it was
not known whether they
[Note: Of those
the onset of labour]
hospital to the main labour
ward; however, there are
delivery suite unless a
MLU, commencing at
antenatal care. Unclear
whether women would
case of complications, or
Outcomes and
Results Comments
Previous medical history:
women booked at the
criteria and in 51 cases
it was not
known whether they
met the criteria.
Therefore, 705 women
same time as the
782)
Outcomes and
Results Comments
Previous gynaecological
unit.
consultant obstetrician)
GP. A domino delivery
system (women stay at
few hours later) was
available in both units.
Outcomes and
Results Comments
Transfer criteria
Not reported
Data collection,
Clinical Audit
Outcomes and
Results Comments
stage of the evaluation,
study; therefore, an
virtually all eligible
(12.7)
Gave birth in OU:
Outcomes and
Results Comments
those who booked the
older. The authors
(n = 11)
close to the labour
in labour
Outcomes and
Results Comments
Journal of Obstetrics and
Hospital
gestation (mean [n])
38 weeks
39 weeks
Planned
bean bag, a lounge
chair and a wash
relevant medical
equipment was
birth room. Suitable
women were offered
the opportunity to
to participate, 148
Labour ward: 3/62
were withdrawn from the
trial are not available
intention to treat. (See
Outcomes and
Results Comments
40 weeks
41 weeks
42 weeks
Inclusion criteria
Exclusion criteria
was the same.
Withdrawal from the
group of midwives in
whether this truly
complication (however,
Outcomes and
Results Comments
reported below)
specially designed
group were withdrawn
labour and before reaching
- intrauterine growth
- post-maturity (n = 3, at
- pre-eclampsia (n = 1, at
37 weeks)
- antepartum haemorrhage
7 were during labour but
before reaching the birth
Outcomes and
Results Comments
and 40 weeks)
- meconium stained fluid (n
= 1, at 39 weeks)
34 and 36 weeks)
birthroom in labour:
weeks)
13 women in the labour
ward were withdrawn
and 37 weeks)
- moved outside area (n =
Outcomes and
Results Comments
- unsuitable for early
weeks)
42 weeks)
Full citation
David,M., von
- significantly more nulliparous
group
worked during pregnancy
10% of hospital group were
single mothers
labour, they were
rounding.
birth centre mothers were
Outcomes and
Results Comments
birth centres
Study dates
Source of funding
debilitating illness, diabetes,
previous caesarean section
morbid obesity, and
prematurity (prior to 37
get comparable low risk
groups. Primary CS and
birth centres. Then, any
group. These are
authors report that the
groups were different.
labour were excluded (any
Outcomes and
Results Comments
postdates, meconium stained
amniotic fluid, non-reassuring
cardiotocograph (CTG) and
than Germany, USA, and
northern or central Europe
birth centre group.
Berlin in general and
therefore, it needed to
birth centres were
lack of demographic
the 2007 guideline]
Primary indications for
operative delivery (n (%))
- Prolonged second stage
Outcomes and
Results Comments
Transfer criteria
Data collection,
Outcomes and
Results Comments
Mann-Whitney or
Outcomes and
Results Comments
Mol,B.W., Nijhuis,J.G.,
Bennebroek,Gravenhorst J.,
Buitendijk,S.E., Perinatal
nationwide cohort of
529,688 low-risk planned
Characteristics
factors arose during
pregnancy, labour or
the postpartum period,
labour and therefore
in a hospital. Intended
place of birth during
origin, have a medium/high
Blinding of those
assessing outcomes: No
on confounders - parity (n
= 61), maternal age (n =
149), ethnic background (n
Outcomes and
Results Comments
Study dates
December 2006
to be Dutch) and
likely to have medium or high
socio-economic status)
Inclusion criteria
of labour
labour] recorded, which for
midwife forgot to record
planned place of birth.
comparison of interest.
midwife-led care at the
data from academic
hospitals would be
reported; however, they do
birth at term and did not
have complications at the
and therefore their data
Outcomes and
Results Comments
Exclusion criteria
result of risk factors
progress, abnormal
meconium stained
onset of labour)
the 2007 guideline]
Outcomes and
Results Comments
Outcomes and
Results Comments
hours, intrapartum and
days
home versus hospital
Interventions
Planned
Outcomes and
Results Comments
support and home
them, that were judged
given information about
hospital visit. At a
hospital. Randomisation
numbered, opaque
is reported that 1
after randomisation
Home: 0/5 (0)
Hospital: 0/6 (0)
during pregnancy but
Outcomes and
Results Comments
previous pregnancy.
though.
birth, caesarean section
(CS), and instrumental
vaginal birth are
onset of labour. 1/11
(9.1%) was considered to
previous PPH.
Other information
the 2007 guideline]
Outcomes and
Results Comments
Eide,B.I., Nilsen,A.B.,
same clinic--a prospective
Ref Id
conventional care unit
N = 453
Conventional delivery
standard antenatal
b. Forceps
c. Vacuum
in their calculations.
Outcomes and
Results Comments
collection for the
conventional delivery ward
women expressing desire
standard antenatal
d. Emergency
caesarean section
Valid and reliable method
the event of complications
or request for epidural.
However, in the second
stage of labour women
emergency caesarean was
needed and obstetricians
case of complications.
typical alongside midwifery
unit because some
instrumental vaginal births
Outcomes and
Results Comments
(%))
The two units are
located on the same
floor. They share the
midwives between the
women who met the
Perineal tears of
(%))
not incorporated in the
complications; however,
Outcomes and
Results Comments
(p = 0.003)
paper; however, the technical
typo otherwise the categories
Inclusion criteria
the MLW:
and 42 weeks gestation
was planned before
admittance in 162
the MLW.
(n = 103, 51%) and
safer for mother and
infant (n = 42, 21%)
Outcomes and
Results Comments
MLW at various times
Outcomes and
Results Comments
Women were
labour. In the second
stage of labour, women
CDW unless an
emergency CS was
the CDW cohort)
calculated that 200
what outcome this is
Outcomes and
Results Comments
comparison of hospital and
birth center settings, Birth,
had a low risk
pregnancy at 37 weeks
Outcomes and
Results Comments
Ref Id
hospital birth centre
an out-of-hospital
consisted of 77 women
enrolled at the centre
and giving birth during
the study period. Any
done
less likely to be Hispanic.
Apart from that, the
and marital status.
Outcomes and
Results Comments
Hospital: 6.9
groups had finished high
compared to the hospital
group (95% compared with
Exclusion criteria
Incomplete chart
criteria at 37 weeks
they were excluded, as
were any women with
Association health care
facility, licensed to
denominator of 77
and no further
details are given]
delivered by obstetricians,
- Population: 4.2% of the
the Childbearing Centre
the 2007 guideline]
Outcomes and
Results Comments
intrapartum unit
of their choice. Families
could leave within 12
hours of birth, during
Outcomes and
Results Comments
teaching hospital,
calculations does
Outcomes and
Results Comments
two-bed labour rooms.
The procedures varied
throughout labour and
rooms. Neonates were
nurse or paediatric
house staff. Private
patients generally spent
several hours in
recovering and then
outcome for women
planning birth in
Outcomes and
Results Comments
Outcomes and
Results Comments
neonatal mortality are
Outcomes and
Results Comments
1404, 1994
Ref Id
Sample size
N = 2844
789]
793]
915]
single rooms, located
safe, homely
environment where
Doppler, active labour
was encouraged, and
there was minimal
intervention. The unit
Results
Outcomes and
Results Comments
Study dates
August 1993)
Multiple pregnancy
3451 women identified
up in addition to the 63
(2.2%) that miscarried or
had an abortion; unclear
what denominator is for
perineum, episiotomy and
Outcomes and
Results Comments
favour of the MLU due
to the expected rate of
transfer, in order to
the MLU was fully
midwife unit by medical
Outcomes and
Results Comments
as possible after birth
the database manually
stillbirth, the fetal
due to fetal
abnormality. In the
direct result of a
Outcomes and
Results Comments
women randomised
Outcomes and
Results Comments
MLU: 24/1820
hours
Outcomes and
Results Comments
Outcomes and
Results Comments
Outcomes and
Results Comments
Outcomes and
Results Comments
- Multigravida: 16
Outcomes and
Results Comments
Outcomes and
Results Comments
hospital birth between 2003
2006
was: "home", "other out
of hospital" (there are
hospital arm when
in each arm
days'
Outcomes and
Results Comments
been combined by the
technical team, as the
distinction between north and
south is not relevant
these situations. In
physician was
documented. Two
experienced midwives
birth was intended to
take place at home.
There were 419 records
least one previous CS
- 33/6692 (0.5%) of the
planned home birth arm
35-37 weeks
birth were post-term
hospital birth arm had
hospital arm had ARM
'unknown' and therefore
identify those not
Outcomes and
Results Comments
antenatal transfer of
classified. The authors
discrepancies in the
midwife erroneously
home birth, when in fact it
had just been planned or
desired at an earlier point
in pregnancy.
Other information
the 2007 guideline]
Outcomes and
Results Comments
Hospital: 11.0
breeches (0.2%) in the
birth arm
Inclusion criteria
or comparable low-risk women
care with unclear
possible return to
primary analysis will be
reported in the GRADE
reported.
onset of labour. To
select a low-risk cohort,
home birth would have
Outcomes and
Results Comments
suggested that care was
or there were interventions
inconsistent with home birth
1) and previous CS
(none or 1) and
0.90)
Estimated
Outcomes and
Results Comments
Outcomes and
Results Comments
42 days
(n/total (%))
Outcomes and
Results Comments
8. Composite perinatal
and neonatal mortality
or serious morbidity:
following:
minutes
Outcomes and
Results Comments
- neonatal resuscitation
than 4 days
Outcomes and
Results Comments
Outcomes and
Results Comments
Hospital: 85/2298
Outcomes and
Results Comments
Outcomes and
Results Comments
planned home
births, 1364/2293
(59.5%) of
nulliparous women
and 3891/4393
(88.6%) of
multiparous women
Outcomes and
Results Comments
physician (n/total
Outcomes and
Results Comments
Outcomes and
Results Comments
2.9)
> 35
of prenatal care, and
they remained in their
Birth centre eligibility
criteria (see exclusion
criteria above) were
confounders
history, race/ethnicity,
Outcomes and
Results Comments
0.2)
8.3)
5.3)
- 4.0)
in the birth centre
21.5)
18.3)*
-7.2)
control for these
2014 eligible women in
women in traditional care,
Outcomes and
Results Comments
to 28.4)
White, non-Hispanic
to -9.2)
African American
to -7.0)
-2.7)
traditional care group
originated from Mexico]
done by providing
certified nurse midwives
(CNMs) with abstracted
2 CNMs reviewed each
decision. A
perinatologist familiar
-5.7)
2.2)*
maintain sample size.
- Population: 16.9% of birth
traditional care group had
prior medical or pregnancy
traditional care group were
induced with oxytocin or
group and 4.5% of
traditional care group were
small for gestational age;
Outcomes and
Results Comments
0)
7.1)
to 3.4)
-2.9)
women not being
recruited at prenatal
were added to the
1345 eligible women in
traditional care. Then a
further 87 women had
population were Hispanic,
most UK settings
updated guideline]
Outcomes and
Results Comments
0.7)
1.1)
3.4)
positive, prior pregnancy
3 components:
freestanding birth
(n/total (%))
1.2)
1.5)*
2.6)
Outcomes and
Results Comments
Birth weight (n (%))
1.3)
0.4)
3.0)
obstetricians. When
and was within 15
minutes of 3 hospitals.
environment, where
intermittent auscultation
was done after 24-48
hours, and then a
4.0)*
Adjusted difference
5.3)*
0.1)
3.0)*
Outcomes and
Results Comments
provided:
- Undocumented uterine scar
insurance (because focus was
on low income women)
33 weeks or later
setting. The hospitals
had 24 hour
Adjusted difference
0.3)
Outcomes and
Results Comments
collected from medical
records. Women also
completed a self-
low incidence of some
Collaborative:
0.2)
0.1)‡
0.1)
Outcomes and
Results Comments
0.7)
0.2)‡
1.9)‡
Outcomes and
Results Comments
2.4)‡
Neonatal
0.2)
1.5)‡
Outcomes and
Results Comments
Outcomes and
Results Comments
they intended to give
the eligibility
Outcomes and
Results Comments
home birth by comparing
0.92
0.002
Pre-pregnancy
they still intended to
met eligibility
birth. The attendant
care giver, it recorded
illicit drugs
Groups received
given
arm (midwife and
Outcomes and
Results Comments
0.05
0.001
Parity
0.54
0.001
0.01
0.001
induction of labour with
arm had pregnancy
congenital anomalies
the 2007 guideline]
Outcomes and
Results Comments
(CS) (n (%))
0.001
0.002
0.001
0.001
women who were lone
the household
analysis and monitoring
database. In the
hospital after planning a
home birth. Data from
accessed by reviewing
0.017
0.05
0.001
0.001
0.002
0.28
Outcomes and
Results Comments
of the other groups.
or hospital
Exclusion criteria
home birth. These criteria
class unknown)
labour. Categorical
variables were
0.001
0.40
0.16
Home vs. MA hospital:
Outcomes and
Results Comments
37 weeks or more than 41
weeks at the onset of labour
- more than one previous CS
- mother transferred to hospital
transfusion are
0.32)
0.35)
0.33)
Home vs. PA hospital:
1.00
1.00
- Other
Home vs. MA hospital:
Outcomes and
Results Comments
0.69)
Vaginal/perineal
Outcomes and
Results Comments
1.63)
Outcomes and
Results Comments
Outcomes and
Results Comments
1.45)
1.38)
Outcomes and
Results Comments
Outcomes and
Results Comments
there was no final
Outcomes and
Results Comments
(HIE) with
haemorrhage and
Outcomes and
Results Comments
c. Meconium
the MA hospital arm
Outcomes and
Results Comments
Outcomes and
Results Comments
asphyxia: 2
- newborn with
distended abdomen:
Outcomes and
Results Comments
Liston,R.M., Lee,S.K.,
the woman's home at
planned place of birth
change 'substantively';
nulliparous
Outcomes and
Results Comments
Study dates
pregnancy (n (%))
hospital. They then
restricted the population
to those women
hospital with a
2:1 basis by:
risk of bias as a result of
misclassification of
the data were reported
group had major
Outcomes and
Results Comments
weeks of pregnancy
caesarean section (CS)
Mother has not been
transferred to the delivery
hospital from a referring
based study
Transfer criteria
it is a population-based
Outcomes and
Results Comments
Significant pre-existing
diabetes
antepartum haemorrhage after
20 weeks' gestation,
gestational diabetes requiring
with 95% confidence.
The Perinatal Database
source of women, and
Outcomes and
Results Comments
database, with < 0.01%
included.
10%.
Outcomes and
Results Comments
degree, and those with
life
Outcomes and
Results Comments
Outcomes and
Results Comments
Outcomes and
Results Comments
PA hospital: 0.64
[Note: There were
Outcomes and
Results Comments
Outcomes and
Results Comments
Outcomes and
Results Comments
nervous system,
a conventional setting: a
Outcomes and
Results Comments
québecois de la recherche
Bronfman Family
bleeding on arrival, meconium
stained amniotic fluid, post-
her partner
- "routine" perineal
unlikely to be guaranteed
resembles an alongside
Outcomes and
Results Comments
mother and partner
authors report that a
participating
not well described. The
a "single obstetric and
settings" and that
Other information
Comparison: ALONGSIDE
Hodnett et al.]
whether a doctor may have
Outcomes and
Results Comments
the next allocation, and
initially eligible and
enrolled, 30% were
Outcomes and
Results Comments
Outcomes and
Results Comments
demand to participate.
Outcomes and
Results Comments
conventional setting
birth.
frequency of
Outcomes and
Results Comments
distress, and 6 due
Outcomes and
Results Comments
epidural anaesthesia
the woman had decided
home with contractions
or rupture of
membranes. This was
considered a planned
home birth regardless
for this
hospital group. Women in
the planned home birth
group were more often:
born in another country,
employed in areas where
Outcomes and
Results Comments
adverse outcome for mother
and child following planned
home births, regardless of
where the birth actually
December 2004
outcomes of births
p = 0.002 (for
BMI data missing; in
addition, they report that
141 births that were
reported as planned home
study because there was
no information about them
Outcomes and
Results Comments
during the study period
Full-term birth registered with
groups were selected, see
further analysis
other sources were
during the study period
(n = 448) recruited this
way. All midwives and
women were asked if
they knew of other
'snowball' method did
0.9)†
1.3)†
the possibility that some
planned home births were
identifying them
performed: Yes
vaginally) and 146/11341
Outcomes and
Results Comments
replied and had 1038
planned home births. Of
these, 100 women (141
births) were not found
was reported that 100
there was any
0.4)
p = 0.01 (for
0.2)
p < 0.001 (for
the 2007 guideline]
find a licensed midwife
pay for it herself.
Outcomes and
Results Comments
- Adjusted RR 0.5
Uterine rupture
Home: 0/897
Hospital: 11/11341
day 1 following a
Outcomes and
Results Comments
3. Haemorrhage:
gestation; born with
day 19 following a
vaginal birth with no
pain relief; 37 weeks
day 0 following
Outcomes and
Results Comments
day 0 following
day 0 following
day 2 following
day 2 following
Outcomes and
Results Comments
day 2 following CS;
day 9 following
randomised controlled trial,
Control: 25.4 ± 4.6
Maternal height/cm (mean ±
the experience of
childbirth for women
Outcomes and
Results Comments
Ref Id
care during the antenatal
period and at delivery.
1990
Control: 162.1 ± 6.0
Control: 326 (29.8%)
Control: 457 (38%)
Control: 600 (48%)
Control: 149 (12%)
Control: 560 (46%)
because only one arm
participating in a trial.
however, no details about
the Home from Home
missing data. 189/2304
(8.2%) of women
Outcomes and
Results Comments
Leicestershire Health
Control: 570 (47%)
Control: 76 (6%)
system, and were not
randomise women,
appointment clerks
attached sealed
from the outside. Twice
as many women were
allocated to the Home
control arm and the
% do not match if
you use the number
Home arm for transfer
outcomes. Out of 2304
reported
hypertension, post dates,
abnormality.
Outcomes and
Results Comments
Multiple pregnancy
Rhesus antibodies
consultant, it was
decided whether she
explanation of the
Home from Home
delivery)
package of care, from
Outcomes and
Results Comments
woman refused to take
the control group.
However, she was
which she was
Outcomes and
Results Comments
The rest of their
Intervening care was by
the control group
from Home group.
Outcomes and
Results Comments
delivery bed.
Outcomes and
Results Comments
made the decision
about whether women
women in each arm
would be feasible in
Outcomes and
Results Comments
Outcomes and
Results Comments
Outcomes and
Results Comments
Outcomes and
Results Comments
Outcomes and
Results Comments
200 women.
Full citation
Nove,A, Berrington,A,
observational study of over
500,000 maternities in the
UK, BMC Pregnancy and
Childbirth, 12, 130-, 2012
the incidence of PPH
intended than if a hospital
birth was intended"?
(%))
range of location and
Results
Postpartum
3.8; p < 0.001)
not reported
Groups received
data for the outcome
extracted from the
Outcomes and
Results Comments
Study dates
PhD which was funded by
the Economic and Social
pregnancy (n/total (%))
the following criteria
performed: Women
low risk - these were
women meeting the criteria
from the 2007 guideline
that are listed as
the 2007 guideline]
Outcomes and
Results Comments
1989: 21939/273872
1990: 22311/273872
1991: 22108/273872
1992: 22040/273872
1993: 21077/273872
1994: 21014/273872
Inclusion criteria
Exclusion criteria
birth or stillbirth (i.e.
maternal International
Information System (SMMIS)
2007 guidance - i.e. those
unit".
Note:
to 3.7)
Outcomes and
Results Comments
result of the exclusion
Outcomes and
Results Comments
Setting/care protocol
reported who by.
Adjusted analyses were
performed using a
Outcomes and
Results Comments
on PPH. Other
covariates were not
on explanatory
Outcomes and
Results Comments
included as a covariate
1000 ml
Full citation
low-risk women, BMJ Open,
low risk and fulfil the
criteria for an FMU birth
at the onset of labour
(see inclusion criteria).
All labouring women
for this
Outcomes and
Results Comments
freestanding midwifery units
they were a matched to
one of the women in the
FMU group. They were
to 0.6)
c. Caesarean
to 0.9)
p = 0.04
† FMU midwives
acute fetal distress
Missing data/loss to follow-
what constituted severe
the FMUs. For these
birth would have been
known and the authors
of these women. However,
women were enrolled
Outcomes and
Results Comments
to 0.7)
p = 0.0001
to 1.7)
p = 0.6900
Intact perineum
to 1.2)
p = 0.0142
a subgroup analysis
systematic differences or
deviation of results
data.
and age, as long as their
previous pregnancies and
labours were not
Outcomes and
Results Comments
education
education
education
area (whether they had
births).
provincial hospital
generalised paediatric
births per year).
to 0.97)
p = 0.0154
to 1.4)
p = 0.5224
to 0.9)
p = 0.0002
transfer by ambulance was
the life of the FMU, an
adverse event occurred
against protocol - there
gynaecologist (who had
FMU) was summoned and
the 2007 guideline]
Outcomes and
Results Comments
Occupation (n (%))
Low risk:
weeks gestation
- Uncomplicated pregnancy
the FMUs, by which
time only 550 FMU
to 1.0)
p = 0.0599
Severe maternal
morbidity (n/total
Outcomes and
Results Comments
previous pregnancies and
births had been
FMU for emergency treatment
without satisfying the criteria
who had been admitted
opening of the second
FMU in March 2004.
in each arm. Re-run
women.
severe diaphramic
to 1.1)
p = 0.1143
to 1.9)
p = 1.00
Outcomes and
Results Comments
to 1.1)
p = 0.1143
to 1.1)
p = 0.1480
to look for
Outcomes and
Results Comments
blood loss was
Outcomes and
Results Comments
Outcomes and
Results Comments
Outcomes and
Results Comments
Outcomes and
Results Comments
h. Retained
placenta/PPH > 500
Outcomes and
Results Comments
adjust for these
baseline: Women intending
older, more likely to be
married, white, non
Outcomes and
Results Comments
midwife, nurse or
attendant was not
facility were consider
weeks gestation who
area, to have initiated
prenatal care during the
birth to infants weighing <
study; therefore no details
for 2.7% of home birth arm
and 7% of hospital birth
arm for the outcome of
postpartum bleeding
Outcomes and
Results Comments
Exclusion criteria
Pregnancy related
home.
(95% CI 1.06 to
data were collected.
not formally recorded on
the birth certificates, the
authors were forced to
misclassification of
authors in their discussion
of limitations. They report
that they attempted to
minimise this by excluding
those with complications.
Outcomes and
Results Comments
home):
- diabetes
- polyhydramnios
- oligohydramnios
least 37
weeks)
attended by physicians.
2007 guideline]
Outcomes and
Results Comments
10%
Outcomes and
Results Comments
gestation, 269
reported; however, the authors
Interventions
Planned
screened at the initial
confounders
Outcomes and
Results Comments
Ref Id
compared to a hospital
background and financial
women were
rejected as ineligible
remaining group of 580
centre and were well-
screened and low risk.
hospital group women
for the whole of
PPH it is unclear what the
denominator is (specifically
not reported for PPH or
mode of birth.
outcomes: Haemorrhage is
physicians, which is less
Outcomes and
Results Comments
Birth centre: 3.2
Receiving prenatal care from
rise building outside of
reported what the
the 2007 guideline]
weeks onwards.
Outcomes and
Results Comments
table]
weeks. The remainder
by the nurse midwives.
labour were
Outcomes and
Results Comments
interventionist
needed; however, there
centre, and then return
Hospital
care facility serving
3 mothers were
Outcomes and
Results Comments
were no fetal heart
hotline system
Outcomes and
Results Comments
meconium stained
transferred to hospital.
Any other complications
Outcomes and
Results Comments
education status and
month when prenatal
care started. This
generated another list,
for which medical
records were obtained,
reported; however, in
Outcomes and
Results Comments
not reported)
Full citation
low-risk pregnancy,
20s who had private insurance
coverage and were generally
multiparous. They also report
differences in any
low-risk birth centre
reported)
different at baseline
Outcomes and
Results Comments
eligible at 34-36 weeks
English speaking, reading and
vaginal birth (therefore
by midwives
Other information
Outcomes and
Results Comments
priority outcomes
the 2007 guideline]
low-risk pregnancies,
birth was unknown; therefore
is 622,017)
it was coded as
0.91)
more likely to be
multiparous, at least 25
neighbourhood. In babies
'Big 4' condition
Outcomes and
Results Comments
community midwife-led
potential conflicts of interest
b. Perfect guideline approach
significant effect on
not reported
population had planned
'unknown'
Outcomes and
Results Comments
and allowed them to
of labour. Non-
than 41 weeks,
prolonged rupture of
membranes (more than
24 hours), and
intrauterine death with
unclear timing relative
602331 women are
included for this
approach, which still
onset of labour)
the 2007 guideline]
2009)
Outcomes and
Results Comments
Outcomes and
Results Comments
population was defined
'Big 4', which represent
Outcomes and
Results Comments
more likely to be of Dutch
origin and to live in a
privileged neighbourhood.
Inclusion criteria
Outcomes and
Results Comments
(defined as spontaneous
contractions or spontaneous
rupture of membranes)
than 30)
community midwife at the
Outcomes and
Results Comments
17-26, 1997
Ref Id
birth centre care on
study (when the birth centre
had just opened), women
enrolled later in pregnancy
women were aware of it.
Therefore, most women in the
birth centre arm had made at
least one standard antenatal
care (ANC) visit before
For further details of the study
population, see entry in
Waldenstrom et al., 1997
p = 0.71
p = 0.45
b. Clitoris/labia
group had a miscarriage at
or before 22 weeks; 14 of
the standard care group
up before intrapartum care.
For the 2 month
questionnaire, 97% of birth
control group replied.
greater than the
denominator for 'vaginal
Outcomes and
Results Comments
weight, preterm birth, perinatal
death or difficult vaginal
delivery did not preclude
birth was vaginal. For further
details of the trial, see
Waldenstrom et al., 1997]
birth centre once
women had consented
and completed a
opaque envelope from
possible for the woman
research team to
denominator is compared
to the number
standard care arm had
induction of labour; 1.9%
had elective CS; an
a later vaginal birth to be
included
Outcomes and
Results Comments
- Birth centre
the medical criteria
were still fulfilled.
obstetricians with
medical responsibility
has been included
because it reports
additional outcomes of
Outcomes and
Results Comments
calculation is reported.
3.5 years.
-2.7)
months. Where 'NR'
Outcomes and
Results Comments
Data about
interventions and
months after birth.
Analysis was by
intention to treat;
therefore, those women
not clear whether
Outcomes and
Results Comments
the two tests).
entry in Waldenstrom et
Outcomes and
Results Comments
- Hospital care
Outcomes and
Results Comments
Outcomes and
Results Comments
Outcomes and
Results Comments
Outcomes and
Results Comments
Outcomes and
Results Comments
Outcomes and
Results Comments
Other minor
problems (n/total
when indicated
p = 0.53
Outcomes and
Results Comments
couple Swedish speaking
weight (LBW), preterm birth,
perinatal death or difficult
vaginal delivery did not
labour
to a doctor
p = 0.29
c. Vacuum
p = 0.74
d. Forceps
group had a miscarriage at
or before 22 weeks; 14 of
the standard care group
up. PPH, blood transfusion
and episiotomy are only
reported for women having
reported
standard care arm had
induction of labour; 1.9%
had elective CS; an
Outcomes and
Results Comments
Exclusion criteria
event of complication
hospitals
p = 0.71
p = 0.98
a later vaginal birth to be
included; 1.1% of birth
standard care arm were
born premature; 2.9% of
malformations
the 2007 guideline]
Outcomes and
Results Comments
left)
the medical criteria
were still fulfilled.
p = 0.07
Morbidity
labour with slow progress.
EFM was deemed normal
and the baby was born 29
minutes later after the cup
slipped twice. The baby
damage at discharge.
labour, due to a
Outcomes and
Results Comments
obstetricians with
medical responsibility
delivered by CS. Mother
and baby had convulsions,
probably due to low
care. Earlier transfer,
labour progressed
Outcomes and
Results Comments
calculation is reported.
then extended for a
further 1.5 years to
reduction in CS from
6.3% in birth centre
group, a reduction in
epidural from 16% to
11.4% and an increase
was normal on
auscultation. Baby was
and tomography showed a
and subdurally at the
tentorium edge. EFM may
due to reduced movement
There were no
she continued to feel no
movement. After 8 hours
advised to come in
Outcomes and
Results Comments
Data about
interventions and
their own request are
included in the birth
the onset of labour in 42nd
gestational week. The
midwife was unable to
hear a heartbeat. There
was suspicion of amniotic
admission might have
altered the outcome.
use a handheld ultrasound
monitor, she might also
Outcomes and
Results Comments
the two tests).
Outcomes and
Results Comments
Outcomes and
Results Comments
Outcomes and
Results Comments
birth (n/total (%))‡
Outcomes and
Results Comments
p = 0.13
Outcomes and
Results Comments
Outcomes and
Results Comments
p = 0.003
p = 0.04
Outcomes and
Results Comments
Outcomes and
Results Comments
Outcomes and
Results Comments
Outcomes and
Results Comments
Western Australia 1981-
mother booked
proportion of women with
analysed by 'booked' place
Outcomes and
Results Comments
Study dates
1981 - 1987
and 310 (11%) of women in
hospital group had
in hospital. The
matched cohort of
gestation at birth was
gestation at 'booking' of
home birth. This was
booked with a midwife
based study
coded in the Midwives'
hospital birth. The authors
report being confident that
not identified; however,
hospital birth midwives
report some variables
Outcomes and
Results Comments
child (%)
Exclusion criteria
Multiple birth
Congenital malformations
authors wanted to
excluded the potential
preterm births in the
necessary
- previous stillbirth: yes,
40
performed: Yes
group had medical
conditions, but again,
non-cephalic presentation
Outcomes and
Results Comments
(4%) planned home
were randomly
a population based
a population based
elective CS
Other information
the 2007 guideline]
Outcomes and
Results Comments
birth. This contained
details of medical
history, antenatal care,
labour, birth and
Outcomes and
Results Comments
person, based on death
Outcomes and
Results Comments
recorded pregnancy
complications and
maternal medical
above, they later report
Outcomes and
Results Comments
weeks gestation or
baby within 28 days of
birth (neonatal death)
(n = 1) were excluded]
5. Admission to special
two were late infant
Outcomes and
Results Comments
of baby: 16/976
1.1.2 Maternal and neonatal outcomes associated with different birth settings? HEALTH ECONOMICS
Bibliographic details
at low risk of
regional lead midwives (Liverpool
Women's Hospital NHS Foundation
Trust, Oxford Radcliffe Hospital
the London Trust) for 'bottom up'
Time horizon and
low risk woman planning
labour were:
£1461 for an alongside
midwifery unit
benefits were included
in the analysis.
Therefore the results
collect overhead costs such as
management and administrative
hospital services such as
calculate trust overheads
used to generate running costs, bed
days, occupancy rates, numbers of
women delivering and intrapartum
probabilities
none
low risk women without
£1511 for an obstetric unit
£1426 for an alongside
midwifery unit
costs of care. Also,
there may be a
payment to reflect the
which would lead to
be double counting.
However, the CNST
applied to all births
study. The authors
of complications, maternal
of complications, normal
whole. The economic
modelling required to
do this requires
Incremental cost-
of complications, maternal
of complications, normal
probability of home birth
being the most cost
probability of free standing
midwifery units being the
most cost effective option.
For multiparous low risk
100% probability of being
1.1.3 Women’s experiences and views of different birth settings
Study details Participants Interventions Methods
Outcomes and
Results Comments
Full citation
Waldenstrom,U., Nilsson,C.A.,
center care. A randomized
carried out
centre describing the
trial, procedure and
reasons for random
allocation. At first
telephone contact a
midwife checked that
women met the
inclusion criteria. If
accepted, the woman
met a research
was only through
months after the birth
less disappointed by
for bias caused by
on 7-point scale). No
Outcomes and
Results Comments
centre care on women's
Study dates
Swedish National Delegation for
the Swedish Medical Research
birth centre, before
involved, 7 = very
no disappointment.
Other information
13).
greater Stockholm area and
clinical trial. It was not
possible to obtain birth
trial. Women who had
Outcomes and
Results Comments
anxious
a subsequent pregnancy.
assessing bias due to
second publication
(Waldenstom & Nilsson,
centre and women who
birth centre care voluntarily.
care
Outcomes and
Results Comments
Outcomes and
Results Comments
Dahlen,H.G., Barclay,L.M.,
Australia, Midwifery, 26, 53-63,
carried out
small group of first-time mothers
giving birth at home and in
hospital, and to investigate the
implications of the findings for
maternity services
Study dates
Not reported
Birth at tertiary
consent form signed.
Only one woman
(hospital birth) who
experience. This
helped familiarise
at home were generally
interviewed a few weeks
access.
adequately described.
Other information
transferred to hospital and
hospital, except for one
forceps delivery, had normal
experincing first births and
Outcomes and
Results Comments
a very technical
to have everything
else in your
couldn't control
anything (hospital
and someone else is
Outcomes and
Results Comments
discrete concepts
labelled. Labels
ensure their original
your baby are fine and
well. So I think you
feel a lot more
confident and a lot
more 'at home being
in your home' (home
an emotional
something happening
for me that trust
period afterwards
Outcomes and
Results Comments
(home birth)".
Good communication
reduced fear:
"They explained
feel scared during that
part at all (hospital
thought Oh God! What
Outcomes and
Results Comments
comment on anything
fully understanding or
getting an explanation
happened in that area
invalidated and then
how I'm feeling
Outcomes and
Results Comments
got a whole barrage of
directions from her at
looking at this
machine watching the
(hospital birth".
was sort of lying there
and I did not have
anyone to sort of say
you know, 'don't
Outcomes and
Results Comments
didn't make any
frightening and then if
I'd had someone there
with me I wouldn't
scared because it's
own (hospital birth)".
me every opportunity
a baby. My hospital
Outcomes and
Results Comments
about. I felt
empowered. I felt
control (home/hospital
home to hospital affect
satisfaction with childbirth? A
carried out
Belgium/The Netherlands
Study type
Sample size
N = 592
Expected home,
questionnaires were
38% for midwifery practices.
Authors do not clearly
Outcomes and
Results Comments
satisfaction with childbirth
Exclusion criteria
Not reported
and did. The opposite
was true in the
Numbers add up to give a
total of 592 participants
completed questionnaires
Outcomes and
Results Comments
Outcomes and
Results Comments
midwifery clients in British
Columbia, Journal of Midwifery
2006
carried out
birth experience among women
hospital
Birth Demonstration
point scale on each
period.
670/862 (77.7%) of eligible
group planning home birth.
Outcomes and
Results Comments
months of the study
one of the study
mean Labour Agentry and
441+104 = 545, not the 550
women who planned a home
birth and returned study
reflected in a higher score on
all items of the scale.
Authors report the observed
Labour Agentry Scale items
relative difference. Authors
Outcomes and
Results Comments
active genital
may not be a difference of
clinical relevance".
Outcomes and
Results Comments
being in control
Home birth = 6.21 ±
Outcomes and
Results Comments
being confined
Outcomes and
Results Comments
Outcomes and
Results Comments
carried out
Australian birth centres following
a previous hospital birth
Nursing Fund
mothers participating
familiar midwife
midwife they had met
at least twice during
to do was concentrate
on myself and the
by the nature of the selection
criteria achieved an
uncomplicated birth. Being
and influenced analysis of
Normality and collaboration:
Outcomes and
Results Comments
the birth
in a hospital setting
months after the
part of their
listen to familiar
also feel like a
bond. You can't
should be comparing
participate, four declined the
offer and saturation was
achieved after 17 interviews.
One woman had previously
a previous hospital birth.
is referred to as Coyle et al.,
2001b.
Outcomes and
Results Comments
analysis were
a midwife they had
met at least twice
through with the first
those things. She
Outcomes and
Results Comments
of their birth
Outcomes and
Results Comments
would be transferred
met and didn't know".
Outcomes and
Results Comments
things were pushed on
nuturing care... there
the system taking
positive effect on their
my visits 'whoever is
you that entire time.
leave you, there will
the that same person
there the whole time'.
Outcomes and
Results Comments
difference in being
able to concentrate..."
scary...".
Outcomes and
Results Comments
was thinking to myself:
listen to them?' I
thing but then again
they were saying 'no,
this' and I really ddin't
want to do that...".
in many cases written
birth plans seemed to
Outcomes and
Results Comments
women inform
the choices and
remember thinking
care plan I had
Outcomes and
Results Comments
a large system.
The hospital's inability
to offer choices
resulted in women
perceiving care as
is what we've got, this
is what you get. I
didn't like that
up for the experience".
Outcomes and
Results Comments
then all of a sudden, I
had an epidural, went
and I had different
oh OK".
Full citation
Christiaens,W., Verhaeghe,M.,
Bracke,P., Childbirth
maternity care, Journal of
carried out
Belgium/The Netherlands
Study type
lower W-DEQ scores
compared to women
questionnaires were
38% for midwifery practices.
Outcomes and
Results Comments
and the type of caregiver
chosen
Exclusion criteria
Not reported
is a validated
instrument (in Dutch)
Outcomes and
Results Comments
carried out
home-like than
freestanding midwifery
care in labour.
and BMI were found
Outcomes and
Results Comments
explore the influence of specific
medical and sociodemographic
an unequal distribution of
to-treat analysis was
experienced transfer were
number of cases."
Authors used Bonferroni
< 0.0025.
the evidence summary
Outcomes and
Results Comments
less). Scores were
compared using McNemar's
consistent with primary
transferred but only 16 of
those women returned
Outcomes and
Results Comments
support were
generally not
and the two sub-
Outcomes and
Results Comments
control lost all through
Outcomes and
Results Comments
continuity, choice and control.
Women's views from a
randomised controlled trial of
midwife-led care, British Journal
of Obstetrics and Gynaecology,
carried out
consultant-led labour ward
weeks after delivery
unsatisfied, nothing
it, 10 = an absolutely
Satisfaction - n/N (%)
No statistically
significant difference
in satisfaction
between groups.
follow-up, requested
error, neonatal death or
hospital.
in the study was identical to
that received by other
women booking at local
using Bonferroni correction
Outcomes and
Results Comments
Study dates
every way?"
Midwife-managed unit
= 1291/1654 (78.1%)
Consultant-led labour
ward = 564/768
some ways but not
at all?"
Outcomes and
Results Comments
Midwife-managed unit
n/N (%)
Outcomes and
Results Comments
Consultant-led labour
ward = 384/765
Outcomes and
Results Comments
the way their baby's
time. Most common
reasons for restricted
mobility was woman
attached to monitor,
drip or epidural
Outcomes and
Results Comments
Majority of women
pregnancy, Outcomes
carried out
Sample size
N = 146
Freestanding birth
20s who had private
not reported.)
Outcomes and
Results Comments
07048-01
postpartum. Other
Outcomes and
Results Comments
point Likert type scale,
Australian and New Zealand
Journal of Obstetrics and
carried out
birth centre care - 76%.
considered.
measures made at 12-hours
Outcomes and
Results Comments
philosophical commitment to the
would increase maternal
effective than conventional care.
delivery suite; or
delivery suite. Block
either birth centre care
or delivery suite care.
weeks postpartum.
The 12-hour
p = 0.77)
p = 0.93)
p = 0.30)
(episiotomy and tear rate).
less anxiety'.
Other information
trial. Of the 662 women who
declined, 343/662 (52%)
319/662 (48%) chose the
group transferred to birth
Outcomes and
Results Comments
p = 0.69)
p = 0.35)
Satisfied with
analgesia - n/N (%)
p = 0.94)
Outcomes measured
centre group required
Caesarean section and
centre group actually
augmentation, instrumental
centre delivered in the
problems - due to both of the
centre's birthing rooms being
delivery suite and managers
midwife resulting in delivery
in the delivery suite.
Outcomes and
Results Comments
Sample size
N = 1230
was only through
Outcomes and
Results Comments
carried out
centre compared with standard
Swedish National Delegation for
the Swedish Medical Research
centre describing the
trial, procedure and
reasons for random
allocation. At first
telephone contact a
midwife checked that
women met the
inclusion criteria. If
accepted, the woman
met a research
assistant and gave
birth centre, before
three domains of
29.4% two months after
caused by disappointment,
authors compared outcomes
very little disappointment
point scale). Authors report
results not clearly reported
and differs from method
used in a subsequent
publication of this study.
asked two open-ended
questions about their
Outcomes and
Results Comments
centre in future,
not asked the same
greater Stockholm area and
clinical trial. It was not
possible to obtain birth
trial. Women who had
return to the birth centre with
a subsequent pregnancy.
Outcomes and
Results Comments
responsible for
any decision
regarding transfer
not at all disappointed, 7 =
very disappointed) and the
method for assessing bias
due to disappointment with
allocation to obstetric care
(comparison of birth centre
group outcomes with only
care women who
were not disappointed,
used in the second
centre and women who
birth centre care voluntarily.
Outcomes and
Results Comments
care
multiparous, and if so
whether at least one
hospital setting. However,
Outcomes and
Results Comments
carried out
immediate neighbourhood
women who have childbirth
setting and at a birthing centre
Study dates
1991 – 1992
various times in and
person. No titles, a
know them; they're
the birthing center I
was scared [of birth].
can be scared with
who had previous hospital
Outcomes and
Results Comments
birth assistant
clinic at the hospital,
people are cold, you
are there, [and], you're
a number. Here [you
are] a person, they
the clinic, not caring,
done. Here they make
my fear is that I might
get transferred during
labor [to hospital]".
[at birthing center] it's
different, there are no
Outcomes and
Results Comments
desired. During her
talking to me, just
baby's heart, it wasn't
Outcomes and
Results Comments
felt like a woman
about to give birth".
no control. I had to go
by what they said... I
didn't want to be
Outcomes and
Results Comments
the [labor-delivery-
recovery room]
couldn't or wouldn't
had to make it
carried out
Results
by the nature of the selection
criteria achieved an
uncomplicated birth. Being
and influenced analysis of
Outcomes and
Results Comments
Australian birth centres following
a previous hospital birth
Nursing Fund
Inclusion criteria
in a hospital setting
months after the
part of their
was in labour, I wasn't
examined at all which
interfere with me in
Ongoing relationships with a
'care interactions' and 'care
participate, four declined the
offer and saturation was
achieved after 17 interviews.
One woman had previously
a previous hospital birth.
is referred to as Coyle et al.,
2001a
Outcomes and
Results Comments
principal investigator
Exclusion criteria
Not reported
[manage labour] this
gave me suggestions,
assumption that
hospital, when I was
actually in labour, a
Outcomes and
Results Comments
for one?'
Health professional
weren't allowed to talk
way."
Outcomes and
Results Comments
what we have to do,
this is what we are
going to do'. It wasn't
'this is what we could
do, we have other
what is going to
Outcomes and
Results Comments
Littlefield,V.M., Adams,B.N.,
Ref Id
carried out
older, no identified
Alternative birth centre
= 86.54 ± 6.1, 21
Delivery suite = 85.10
complications (reasons for
Outcomes and
Results Comments
= 24.40 ± 1.0, 21
Delivery suite = 21.10
= 28.03 ± 3.7, 21
questionnaires with sufficient
data for analysis.
= very dissatisfied, 5 = very
Outcomes and
Results Comments
= 335.73 ± 9.72, 21
= 415.18 ± 12.99, 21
center: A pilot study, Birth:
Sample size
189 women
Outcomes and
Results Comments
carried out
to answer the following
term effects of transfer? Is it
possible to prepare people
adequately for the experience?
Study dates
or three months after
after birth.
Interviewees were
responded.
3.6%
Results were not presented
points separately.
Other information
the study period. 254/540
Outcomes and
Results Comments
Sample size
N = 1025
researchers was that 'low
risk' is understood as
meaning different things by
Outcomes and
Results Comments
Journal of the Australian College
of Midwives, 25, e11-e18, 2012
Ref Id
carried out
give birth at home.
home, would you
please describe that
experience or the
situation you are
thinking of?" 34
women were excluded
talk about it.
born at home) and
Met with emotional
corroborated by scientific
Outcomes and
Results Comments
of place in their
into the pigeonholes.”
of some religion that
hospitals…it wasn’t
Outcomes and
Results Comments
Phenomenological Experiences:
carried out
have had a home birth after a
previous hospital birth.
was the difference"
a homebirth, they
everything life and
as unavoidably value-laden
with the researcher's
brackets; facts were set
invariants of an experience"
Outcomes and
Results Comments
Exclusion criteria
ill during the time
failed at their hospital
Outcomes and
Results Comments
same problem.
dilated for 12 hours.
She had an intact
amniotic sac and did
Outcomes and
Results Comments
Tingstig,C., Gottvall,K.,
Grunewald,C., Waldenstrom,U.,
compared with standard
114, 2012
Ref Id
carried out
birth centre group
cases. The number of
Outcomes and
Results Comments
satisfied" to "very
greater extent than
participants in the
standard care group.
Calmness was an
important factor when
unique
Outcomes and
Results Comments
Outcomes and
Results Comments
setting, transfer and maternal
the DELIVER study, BMC
Pregnancy and Childbirth, 14,
carried out
The Netherlands
Study type
Observational trial
Sample size
obstetrician.
paper (especially as
the women planned midwife-
itself (rather than an
Outcomes and
Results Comments
felt by women with planned
home birth and planned hospital
birth.
U / p-value
woman. Totals ranged
women planned midwife-led
itself (rather than an
Outcomes and
Results Comments
labour.
Outcomes and
Results Comments
Women transferred
for prolonged
rupture of
Outcomes and
Results Comments
Outcomes and
Results Comments
Outcomes and
Results Comments
Outcomes and
Results Comments
60.6 / 3.3(1.1-5.5)
Adjusted Nullip:
60.5 / 2.9(0.7-5.2))
1.1.4 What is the appropriate staffing configuration of midwives and healthcare support staff on labour ward to support one-to-one
continuous care during labour?
Full citation
Ball,J., Bennett,B.,
Results
size of units:
group of units were:
validation and
British Journal of
Midwifery, 11, 264-266,
implementing Birthrate
Birthrate is based on a scoring
system which assigns women
Ball, 1992).
throughout the labour, with
the midwife time needed for
postnatal care in hospital and
community together with the
community based antenatal
annum
w.t.e. midwife range: 26.08 -
annum
w.t.e. midwife. Range: 25.04 –
annum
w.t.e. midwife. Range: 22.52 –
The results suggest that although
there are local issues that
influence the number and
distribution of midwives across
range of ratios indicates a
possible framework for large
scale workforce planning, and
birth to 1 w.t.e. midwife per
annum might be appropriate.
linking staffing levels to
Outline of the programme in
England and Wales 2001 -
101 maternity services
England had completed their
of 6 months data, gained from
n = 68680 hospital births with
a further n = 1520 home
births. There were variety of
sizes and types of units. These
consisted of:
2500 hospital births per annum
Group 2: 14 units with 2501 –
3500 hospital births per annum
Group 3: 15 units with 3501 –
5800 hospital births per
needed for women receiving
allocation of 38 hours per woman
for all antenatal, intrapartum, and
postnatal care (Ball, 1996).
the ratios of such births per w.t.e
midwife per annum arise from
differences in allowances for
The ratio of home/caseload
ratio of 35.5 births to 1 w.t.e.
midwife. Range: 34 – 37.5
load based to 1 w.t.e. midwife per
annum.
trust in 2006 and 2007. The
tool was then tested via pilot
Results
Limitations
British Journal of
Midwifery, 18, 780-785,
maternity services ranged from
per annum). The tool provides
an ongoing record of workload
in the labour ward and
subsequently the number of
workload. The tool enables
labour progress. Applying the
receiving care, their category
ward acuity and the number of
midwives needed to match it
can be calculated.
were used and the scoring
system was changed to
admission, at delivery or for
post-delivery emergencies (for
fetal monitoring which would
III needing 1.2 midwives. The
woman could then have a
normal delivery and a healthy
bab

appendix i: evidence tables - nice

Documents