Planned Birthing Outcomes: A Meta-Analysis Lindsey Harper Mentor: Dr. Paige Muellerleile Marshall SURE!

Home v. Hospital Birth: According to Wax et al. Planned home birth ↓ medical interventions ↓ infections ↓ hemorrhages ↓ retained placentas Perinatal mortality was similar in both planned locations The neonatal mortality rates are 3 times higher in planned home birth, than planned hospital birth- nonanomalous causes Planned home birth results in fewer medical interventions, infections, hemorrhages, and retained placentas.

Home v. Hospital Birth: According to Wax et al. Perinatal mortality “stillbirth of at least 20 weeks or 500 g or death of live born within 28 days of birth” similar in both planned locations Neonatal mortality “death of a live born within 28 days of delivery” rates are 3x higher in planned home birth than planned hospital birth Perinatal mortality was similar in both planned locations The neonatal mortality rates are 3 times higher in planned home birth, than planned hospital birth- nonanomalous causes

Moderating Factors The year of study – studies range from 1978-2012 Country: homebirth is more common in the Netherlands, but accounts for fewer than 1% in U.S. Mean age: We have studies ranging from < 19 and > 40 Environmental Setting – e.g., rural, urban, metropolitan This is more of an access to resources moderator Practitioner, one study specifically mentions licensed midwives v. lay midwives. Lay Midwives have 24 times the risk of infant mortality

Neonatal and Perinatal Definitions Additional categories and definitions continue to be listed, which means Dr. M and I will be creating subcategories: Stillbirths only (perinatal), if possible Early Neonatal (one day up until eight days old) Late Neonatal ( eight days old until 28 days)

Additional Studies and Collaboration After comprehensive searches on Midwifery and AJOG: 35 Studies for possible inclusion, after further analysis, 23 definite inclusion. We finally got an OB to agree to collaborate, though he’s super biased against home birthing. We’re still waiting on him to get back to us with his analysis of the Wax, 2010 meta-analysis.  This project is on hold until we can talk to him.

In the Meantime. . . Meta-analysis of fear and childbirth Well-being of baby and potential complications of women’s own health and well-being Biological process of giving birth (pain, labor process, and possible medical interventions) Vaginal births are “dangerous”, “frightening”, “unpredictable” Women are afraid that vaginal birth will create a loss in “dignity.” Meta-analysis on self-efficacy in childbirth was a flop due to few studies being published after 1990

Project SCRATCH Sustainable Community Revitalization in Appalachia Through Children’s Hands Edited and submitted pieces for IRB renewal application On site interactions with the kids and garden Put together consent packets

Sex Education Meta-analysis Looking to see if comprehensive sex education or abstinence only sex education causes an increase in particular outcomes, such as: Unplanned teenage pregnancies Use of contraceptives at last intercourse Use of contraceptives at first intercourse Knowledge or awareness of STI’s Contracting STI’s Also seeing if we can relate it to Title IX, Explain Barboursville Middle Sex Segregated Class

References Chang, J., & Macones, G., (2011). Birth outcomes of planned home births in Missouri: A population-based study. American Journal Of Perinatology, 28(7), 529-536. doi:10.1055/s-0031-1272 Fenwick, J., Gamble, J., Creedy, D. K., & Bayes, S. (2010). Why do women request caesarean section in a normal, healthy first pregnancy?. Midwifery, 26(4), 394-400. doi:10.1016/j.midw.2008.10.011 Fisher, C., Hauck, Y., & Fenwick, J. (2006). How social context impacts on women’s fears of childbirth: a Western Australian example. Social Science & Medicine, 63(1), 64-75. MacDorman, M. F., Mathews, T. J., & Declerq, E. (2012). Home births in the United States, 1990-2009. NCHS Data Brief, No. 84. Hyattsville, MD: National Center for Health Statistics.