PubMed · 7337580
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1981. Drinks anyone?. https://pubmed.ncbi.nlm.nih.gov/7337580/
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OBJECTIVE: To assess procedures and outcomes in deliveries planned at home versus those planned in hospital among women choosing the place of delivery. DESIGN: Follow up study of matched pairs. SETTING: Antenatal clinics and reference hospitals in Zurich between 1989 and 1992. SUBJECTS: 489 women opting for home delivery and 385 opting for hospital delivery; the women comprised all those attending members of the study team for antenatal care and those attending the reference hospital for antenatal care who could be matched with the women planning home confinement. MAIN OUTCOME MEASURES: Need for medication and incidence of interventions during delivery (caesarean section, forceps, vacuum extraction, episiotomy), duration of labour, occurrence of severe perineal lesions, maternal blood loss, and perinatal morbidity and death. RESULTS: All women were followed up from their first antenatal visit till three months after delivery. Referrals during pregnancy (n = 37) and labour (70), changes of mind (15 home to hospital, eight hospital to home), and 17 miscarriages resulted in 369 births occurring at home and 486 in hospital. During delivery the home birth group needed significantly less medication and fewer interventions whereas no differences were found in durations of labour, occurrence of severe perineal lesions, and maternal blood loss. Perinatal death was recorded in one planned hospital delivery and one planned home delivery (overall perinatal mortality 2.3/1000). There was no difference between home and hospital delivered babies in birth weight, gestational age, or clinical condition. Apgar scores were slightly higher and umbilical cord pH lower in home births, but these differences may have been due to differences in clamping and the time of transportation. CONCLUSION: Healthy low risk women who wish to deliver at home have no increased risk either to themselves or to their babies.
OBJECTIVE: To document the outcome of planned and unplanned births outside hospital. DESIGN: Confidential review of every pregnancy ending in stillbirth or neonatal death in which plans had been made for home delivery, irrespective of where delivery eventually occurred. The review was part of a sustained collaborative survey of all perinatal deaths. SETTING: Northern Regional Health Authority area. SUBJECTS: All 558,691 registered births to women normally resident in the former Northern Regional Health Authority area during 1981-94. MAIN OUTCOME MEASURE: Perinatal death. RESULTS: The estimated perinatal mortality during 1981-94 among women booked for a home birth was 14 deaths in 2888 births. This was less than half that among all women in the region. Only three of the 14 women delivered outside hospital. Independent review suggested that two of the 14 deaths might have been averted by different management. Both births occurred in hospital, and in only one was management before admission of the mother judged inappropriate. Perinatal loss to the 64 women who booked for hospital delivery but delivered outside and to the 67 women who delivered outside hospital without ever making arrangements to receive professional care during labour accounted for the high perinatal mortality (134 deaths in 3466 deliveries) among all births outside hospital. CONCLUSIONS: The perinatal hazard associated with planned home birth in the few women who exercised this option (< 1%) was low and mostly unavoidable. Health authorities purchasing maternity care need to address the much greater hazard associated with unplanned delivery outside hospital.
The authors utilize an analytic strategy that combines tree-based analyses with the method of Mantel-Haenszel to evaluate the association of 11 putative risk factors to spontaneous abortion by controlling for 19 potential confounders. Logistic regression is also used for comparison. The data for this study were collected in southern Connecticut, during 1988-1991. The putative risk factors are employment; standing, walking, or sitting more than 2 hours at work; exposure to vibration at work; commuting to work; reaching over the shoulders at work; carrying loads over 9 kg on the job; drinking alcohol or coffee in the first month of pregnancy; and gynecologic problems before pregnancy. The potential confounding factors are maternal age, marriage status, race, years of education mother's height, use of birth control, number of pregnancies, smoking before pregnancy, years of smoking, whether the mother stopped smoking, smoking marijuana, passive exposure to marijuana, chronic problems, infertility cocaine use and history of negative pregnancy outcomes. This analysis indicates that carrying loads over 9 kg on the job at least once a day increases the risk of spontaneous abortion by 70% (relative risk (RR) = 1.71, 95% CI 1.25-2.32). Drinking three or more cups of coffee daily in the first month of pregnancy also elevates the risk of spontaneous abortion (RR = 2.34, 95% CI 1.45-3.77). Reaching over the shoulders at least once daily has a marginally significant impact on spontaneous abortion (RR = 1.35, 95% CI 1.02-1.78). The authors conclude that this analytic strategy offers an efficient approach to the exploration of new risk factors for a disease where many potential confounders already exist.