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Home-like versus conventional institutional settings for birth

  • Review
  • Intervention

Authors


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. Date of last search: July 2001.

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

Six trials involving almost 9000 women were included. Substantial numbers of women allocated to home-like settings were transferred to standard care before or during labour. Allocation to a home-like setting was associated with lower rates of intrapartum analgesia/anaesthesia (odds ratio 0.82, 95% confidence interval 0.72, 0.93), augmented labour (odds ratio 0.72, 95% confidence interval 0.64, 0.81), and operative delivery (odds ratio 0.85, 95% confidence interval 0.70, 0.96) , as well as greater satisfaction with care. 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).

Reviewers' 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.

Plain language summary

Synopsis

Home-like settings bring some benefits for childbirth

A home-like birth centre is an option for some women who are considered to be at a low risk of developing complications during labour and birth, and who desire little or no medical intervention. These centres are established near a conventional labour ward and are intended to mimic a home rather than a hospital environment. The review of trials found some benefits for mothers from home-like settings for childbirth, but increased support for caregivers may be more important than the type of institutional setting.

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