Midwifery in Hospitals and Homes

by cmoel2 on October 22, 2013 - 12:01am

          I read the article "Are First-Time Mothers Who Plan Home Birth More Likely to Recieve Evidence-Based Care? A Comparative Study of Home and Hospital Care Provided by the Same Modwives", published by Suzanne Miller, RM, MMid, and Joan Skinner, RM, PhD in the journal Birth. The objective of Miller and Skinner's study was to observe the birth outcomes of first-time mothers giving birth in hospitals and at home with the same midwives (Miller & Skinner 2012). At the same time, they studied the ways in which the midwives were able to do their jobs and how their job roles differed depending on the location. The method of the study was creating two focus groups, one group who planned on giving birth in a hospital, and one group who planned on giving birth at home and then observing their births. These women were all low-risk patients, most of whom were selected from the hospital on the day of their labor. Also, there was a focus group of midwives who were the midwives delivering the babies of the focus group women; these midwives worked both in the hospital and at home during this study. During the course of their labor, Miller and Skinner recorded the number of vaginal examinations, use of monitering equiment, length of each stage of labor, pain medications and pain reduction methods, level of pain for the mother, position of delivery, tearing of the vagina, and other obstetric interventions used to deliver the baby (Miller & Skinner 2012). The major findings of this study were that there were higher rates of obstetric intervention, cecarian surgery and use of forceps etc, in hospital births. Also, the research showed that midwives used more evidence-based practices during home births. Evidence-based learning is making decisions regarding the health of the patient based on the what the patient needs and wants and is the best for them and is suited for their specific environment (Miller & Skinner 2012). In conclusion the results of the study showed that first-time mothers who went through home birth were more likely to give birth with no medical intervention, less complications, and were more likely to receive evidence-based care. 

          Throughout the research article, authors Miller and Skinner cited their references at points where further information might be needed. They were very thorough and used a lot of references to make sure that their work was well supported. For example in the text on page 136, "Some parties have controlled for parity (18,19) and others have not (15-17). In some studies, the same midwives have provided care at home and in the hospital (15,16,19), whereas in others the midwives are in two different settings (17,18)..." Also, the data information was very informative, very thorough, and was very integral in understanding the differences between  the births in hospitals and the births at home. Within the data tables, there were clearly stated percentages and marking to point out the percentage changes within the table between the at home births and the ones in hospitals. An aspect of the article that I didn't expect were the sections on the limitations of the study and on the implications of the study on the practice of midwifery. Miller and Skinner were very clear that their study was small and didn't have large numbers in their focus groups, so they knew their data wasn't conclusive but might be able to provide inspiration for further research and provide information for some people. For example in the section titled Limitations, "The small size of this descriptive study is also a limitation...This information is useful to broaden our understanding, but a larger prospective study would have greater statistical power and external validity." In my opinion, the authors addressed some of the complexities of the issues surrounding midwifery and the stigmas within society about home births being unsafe. After analyzing the data, the conclusions were that home births were less invasive and had better statistics with not needing labor intervention than hospital births did. Also, the paragraph about the implications of this study within the midwifery feild is useful even though the study is small, it did prove a point about home births and the mothers recieving more evidence-based care and delivering their babies in a less stressful environment and that knowledge can help educate women in the future.











This sounds like a fascinating study! I hope to one day become a Midwife and have had the unique opportunity of being able to shadow a few Midwives. I am glad that someone did a study to help debunk some of the common misconceptions that surround the idea of a homebirth. Although I think that both hospital births and homebirths are good choices it is interesting that there seem to be less complications during homebirths than during hospital births. I believe that Midwives play a large (and sometimes unrecognized) role in this aspect of medicine and would be interested to see how many women are choosing Midwives over Women’s Health Doctors now-a-days to deliver their children.
I thought that you did a great job pointing out the strengths of this article and spelling out the procedures that the researchers did. There were one or two places when I was reading that I got a little lost in your long paragraphs but all in all I thought you did a good job of bringing the major facts of this in depth article to light. What is your opinion on homebirths versus hospital births?

I haven't ever thought about this type of birth but your article title really caught my attention, good job! This article and the review done by you are very informative and the statistics really surprised me. Never would I have expected that there would be less complications with an at home birth vs a hospital birth. On top of that it's kind of scary to know that there was more complications within a hospital setting, now where am I suppose to have my child?!
You did a very nice job on this article.

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