Document Detail

Alternative versus conventional institutional settings for birth.
MedLine Citation:
PMID:  22895914     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Alternative institutional settings have been established for the care of pregnant women who prefer 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 setting. Secondary: to determine if the effects of birth settings are influenced by staffing, architectural features, organizational models or geographical location.
SEARCH METHODS: We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (30 March 2012).
SELECTION CRITERIA: All randomized or quasi-randomized controlled trials which compared the effects of an alternative institutional birth setting to a conventional setting.
DATA COLLECTION AND ANALYSIS: We used the standard methods of the Cochrane Collaboration Pregnancy and Childbirth Group. Two review authors evaluated methodological quality. We performed double data extraction and presented results using risk ratios (RR) and 95% confidence intervals (CI).
MAIN RESULTS: Ten trials involving 11,795 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/anesthesia (six trials, n = 8953; RR 1.18, 95% CI 1.05 to 1.33); spontaneous vaginal birth (eight trials; n = 11,202; RR 1.03, 95% CI 1.01 to 1.05); 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 (eight trials, n = 10.931; RR 0.80, 95% CI 0.74 to 0.87); oxytocin augmentation of labour (eight trials, n = 11,131; RR 0.77, 95% CI 0.67 to 0.88); instrumental vaginal birth (eight trials, n = 11,202; RR 0.89, 95% CI 0.79 to 0.99), and episiotomy (eight trials, n = 11,055; RR 0.83, 95% CI 0.77 to 0.90). There was no apparent effect on other adverse maternal or neonatal outcomes. Care by the same or separate staff had no apparent effects. No conclusions could be drawn regarding the effects of continuity of caregiver or architectural characteristics. In several of the trials included in this review, the design features of the alternative setting were confounded by important differences in the organizational models for care (separate staff for the alternative setting, offering more continuity of caregiver), and thus it is difficult to draw inferences about the independent effects of the physical birth environment.
AUTHORS' CONCLUSIONS: Hospital birth centres are associated with lower rates of medical interventions during labour and birth and higher levels of satisfaction, without increasing risk to mothers or babies.
Ellen D Hodnett; Soo Downe; Denis Walsh
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Publication Detail:
Type:  Journal Article; Meta-Analysis; Research Support, Non-U.S. Gov't; Review     Date:  2012-08-15
Journal Detail:
Title:  The Cochrane database of systematic reviews     Volume:  8     ISSN:  1469-493X     ISO Abbreviation:  Cochrane Database Syst Rev     Publication Date:  2012  
Date Detail:
Created Date:  2012-08-16     Completed Date:  2012-09-26     Revised Date:  2013-08-28    
Medline Journal Info:
Nlm Unique ID:  100909747     Medline TA:  Cochrane Database Syst Rev     Country:  England    
Other Details:
Languages:  eng     Pagination:  CD000012     Citation Subset:  IM    
Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Canada.
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MeSH Terms
Analgesia, Epidural / utilization
Analgesia, Obstetrical / utilization
Birthing Centers / organization & administration,  standards*
Breast Feeding / statistics & numerical data
Confidence Intervals
Delivery Rooms
Interior Design and Furnishings
Odds Ratio
Randomized Controlled Trials as Topic
Comment In:
Evid Based Med. 2013 Aug;18(4):e32   [PMID:  23161506 ]
Update Of:
Cochrane Database Syst Rev. 2010;(9):CD000012   [PMID:  20824824 ]

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