Remember Me
Or use your Academic/Social account:


Or use your Academic/Social account:


You have just completed your registration at OpenAire.

Before you can login to the site, you will need to activate your account. An e-mail will be sent to you with the proper instructions.


Please note that this site is currently undergoing Beta testing.
Any new content you create is not guaranteed to be present to the final version of the site upon release.

Thank you for your patience,
OpenAire Dev Team.

Close This Message


Verify Password:
Verify E-mail:
*All Fields Are Required.
Please Verify You Are Human:
fbtwitterlinkedinvimeoflicker grey 14rssslideshare1
Hodnett, Ellen D; Downe, Soo; Walsh, Denis (2010)
Publisher: John Wiley and Sons
Languages: English
Types: Article
Subjects: A990
Background:\ud Alternative institutional settings have been established for the care of pregnant women who prefer and require 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.\ud \ud Objectives:\ud Primary: to assess the effects of care in an alternative institutional birth environment compared to care in a conventional institutional setting. Secondary: to determine if the effects of birth settings are influenced by staffing, architectural features, organizational models or geographical location.\ud \ud Search strategy:\ud We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (31 May 2010).\ud \ud Selection criteria:\ud All randomized or quasi-randomized controlled trials which compared the effects of an alternative institutional maternity care setting to conventional hospital care.\ud \ud Data collection and analysis:\ud We used standard methods of the Cochrane Collaboration Pregnancy and Childbirth Group. Two review authors evaluated methodological quality. We performed double data entry and have presented results using risk ratios (RR) and 95% confidence intervals (CI).\ud \ud Main results:\ud Nine trials involving 10684 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/anaesthesia (five trials, n = 7842; RR 1.17, 95% CI 1.01 to 1.35); spontaneous vaginal birth (eight trials; n = 10,218; RR 1.04, 95% CI 1.02 to 1.06); 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 (seven trials, n = 9820; RR 0.82, 95% CI 0.75 to 0.89); oxytocin augmentation of labour (seven trials, n = 10,020; RR 0.78, 95% CI 0.66 to 0.91); and episiotomy (seven trials, n = 9944; RR 0.83, 95% CI 0.77 to 0.90). There was no apparent effect on serious perinatal or maternal morbidity/mortality, other adverse neonatal outcomes, or postpartum hemorrhage. No firm conclusions could be drawn regarding the effects of variations in staffing, organizational models, or architectural characteristics of the alternative settings.\ud \ud Authors' conclusions:\ud When compared to conventional settings, hospital-based alternative birth settings are associated with increased likelihood of spontaneous vaginal birth, reduced medical interventions and increased maternal satisfaction
  • The results below are discovered through our pilot algorithms. Let us know how we are doing!

    • N C L U S I O Hodnett 2009 {published and unpublished data} Hodnett ED, Stremler R, Weston JA, Mckeever P. Reconceptualizing the hospital labor room: the Place (Pregnant and Laboring in an Ambient Clinical Environment) pilot trial. Birth 2009;36(2):159-66.
    • Hundley 1994 {published and unpublished data} ∗ Hundley VA, Cruickshank FM, Lang GD, Glazener CMA, Milne JM, Turner M, et al.Midwife managed delivery unit: a randomised controlled comparison with consultant led care. BMJ 1994;309: 1400-4.
    • Hundley VA, Cruickshank FM, Milne JM, Glazener CM, Lang GD, Turner M, et al.Satisfaction and continuity of care: staff views of care in a midwife-managed delivery unit. Midwifery 1995;11(4): 163-73. [MEDLINE: 96161080] Hundley VA, Donaldson C, Lang GD, Cruickshank FM, Glazener CMA, Milne JM, et al.Costs of intrapartum care in a midwifemanaged delivery unit and a consultant-led labour ward. Midwifery 1995;11:103-9.
    • Hundley VA, Milne JM, Glazener CM, Mollison J. Satisfaction and the three C's: continuity, choice, and control. Women's views from a randomised controlled trial of midwife-led care. British Journal of Obstetrics and Gynaecology 1997;104:1273-80.
    • Klein 1984 {published data only} ∗ Klein M, Papageorgiou A, Westreich R, Spector-Dunsky L, Elkins V, Kramer M, et al.Care in a birth room versus a conventional setting: a controlled trial. Canadian Medical Association Journal 1984;131:1461-6.
    • Westreich R, Spector-Dunsky L, Klein M, Papageorgiou A, Kramer M, Gelfand M. The influence of birth setting on the father's behavior toward his partner and infant. Birth 1991;18:198-202.
    • MacVicar 1993 {published data only (unpublished sought but not used)} MacVicar J, Dobbie G, Owen-Johnstone L, Jagger C, Hopkins M, Kennedy J. Simulated home delivery in hospital: a randomised controlled trial. British Journal of Obstetrics and Gynaecology 1993; 100:316-23.
    • Waldenstrom 1997 {published data only} Gottvall K, Waldenstrom U. Does birth center care during a woman's first pregnancy have any impact on her future reproduction?. Birth 2002;29(3):177-81.
    • Journal of Reproductive and Infant Psychology 1999;17(4):357-68.
    • Waldenstrom U, Nilsson CA. A randomized controlled study of birth center care versus standard maternity care: effects on women's health. Birth 1997;24:17-26.
    • Waldenstrom U, Nilsson CA. Experience of childbirth in birth center care: a randomized controlled study. Acta Obstetricia et Gynecologica Scandinavica 1994;73:547-54.
    • Midwifery 1994;10:8-17.
    • Waldenstrom U, Nilsson CA. Women's satisfaction with birth center care: a randomized, controlled study. Birth 1993;20:3-13.
    • ∗ Waldenstrom U, Nilsson CA, Winbladh B. The Stockholm birth centre trial: maternal and infant outcome. British Journal of Obstetrics and Gynaecology 1997;104:410-8.
    • Wilhelmson B. First results from a randomized study: ABC for alternative childbirth [Forsta resultat fran randomiserad studie: ABC for alternativ forlossning]. Lakartidningen 1993;90:180-2.
    • Annandale 1987 Annandale EC. Dimensions of patient control in a freestanding birth center. Social Science and Medicine 1987;25(11):1235-48.
    • Deeks 2001 Deeks JJ, Altman DG, Bradburn MJ. Statistical methods for examining heterogeneity and combining results from several studies in meta-analysis. In: Egger M, Davey Smith G, Altman DG editor (s). Systematic reviews of health care: meta-analysis in context.
    • London: BMJ Books, 2001.
    • Fannin 2003 Fannin M. Domesticating birth in the hospital: “Family-centered” birth and the emergence of “homelike” birthing rooms. Antipode 2003;35(3):513-35.
    • Hatem 2008 Hatem M, Sandall J, Devane D, Soltani H, Gates S. Midwife-led versus other models of care delivery for childbearing women.
    • Cochrane Database of Systematic Reviews 2008, Issue 4. [DOI: 10.1002/14651858.CD004667.pub2] Hauck 2008 Hauck E, Rivers C, Doherty K. Women's experience of using a Snoezelen room during labour in Western Australia. Midwifery 2008;24:460-70.
    • Higgins 2009 Higgins JPT, Green S, editors. Cochrane Handbook for Systematic Reviews of Interventions Version 5.0.2 [updated September 2009].
    • The Cochrane Collaboration, 2009. Available from www.cochranehandbook.org.
    • Olsen 2004 Olsen O, Jewell MD. Home versus hospital birth. The Cochrane Database of Systematic Reviews 1998, Issue 3. Art. No.: CD000352. DOI: 10.1002/14651858.CD000352.
    • RevMan 2008 The Nordic Cochrane Centre, The Cochrane Collaboration.
    • Review Manager (RevMan). Computer program. 5.0.
    • Copenhagen: The Nordic Cochrane Centre, The Cochrane Collaboration, 2008.
    • Rooks 1989 Rooks JP, Weatherby NL, Ernst EKM, Stapleton S, Rosen D, Rosenfield A. Outcomes of care in birth centers. The National Birth Center Study. New England Journal of Medicine 1989;321: 1804-11.
    • Ulrich 2004 Ulrich R, Quan X, Zimring C, Joseph A, Choudhary R. The role of the physical environment in the hospital of the 21st century: A once-in-a-lifetime opportunity. http://www.healthdesign.org/ research/reports/physical˙environ.php (accessed 2004).
    • Walsh 2004 Walsh D, Downe SM. Outcomes of free-standing, midwife-led birth centers: a structured review. Birth 2004;31(3):222-9.
    • Hodnett 2005 Hodnett ED, Downe S, Edwards N, Walsh D. Home-like versus conventional institutional settings for birth. Cochrane Database of Systematic Reviews 2005, Issue 1. [Art. No.: CD000012. DOI: 10.1002/14651858.CD000012.pub2] ∗ Indicates the major publication for the study O F Analysis 1.4.
  • No related research data.
  • No similar publications.

Share - Bookmark

Cite this article