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Optimizing maternal and infant health outcomes and the overall delivery experience while minimizing interference is a healthcare matter. The incidence rates and advantages of giving birth in various environments and the danger of medical interventions, have been the subject of intense discussion in recent decades as a result of this topic. Therefore, the PICOT question is as follows: In women who undergo delivery (P), how effective is hospital birth (I) vs. home birth (C) at preventing childbirth mortality rates (O) in a period of 90 days (T)? In this case, it will be additionally essential to give an overview of maternal autonomy in terms of labor setting, progression, and recovery time.
Regarding the childbirth mortality rates issue, the most appropriate kinds of research are qualitative and quantitative since they not only provide the average ratios and incidence rate but also give an overview of the problem. Similar studies have been conducted, and the preferred ways to gather data would be focus groups and case studies. In the case of focus groups, it is possible to evaluate the trends in a bigger community. In contrast, in the situation with case studies, one is capable of gathering data on descriptive cases and analyzing them.
Among the searched studies was the study of Van der Kooy and colleagues. In this study, multiparous women who scheduled a home delivery had a lower modified intervention incidence than those who had a hospital birth. According to the researchers, the most significant finding appears to be the mortality disadvantage experienced by Big3 pregnancies at home, which points to a lack of treatment caused by either delayed timeliness of intervention or an excessive barrier to intervention (Van der Kooy et al., 2017). The distance from the residence to the clinic is a major cause of delays (Van der Kooy et al., 2017). They came to the conclusion that pregnant women had a higher risk of death and unfavorable outcomes when their net vehicle travel time from residence to the hospital was 20 minutes or more. Such results can be integrated into practice when women undergo prenatal care by providing them with the given information.
Another study emphasizes the fact that women who intended to give birth at home had a lower likelihood of undergoing any of the examined intrapartum procedures. These include cesarean section, operative vaginal birth, epidural analgesia, episiotomy, and oxytocin increase (Reitsma et al., 2020). Additionally, they had a lower risk of developing a third- or fourth-degree pelvic floor rupture, a postpartum infection, or vaginal bleeding (Reitsma et al., 2020). The following original study by Nethery and colleagues (2021) corroborates the given fact and claims that planned home deliveries had comparable risks to planned births in birth centers. The researchers make an addition that nulliparous women, implying women who had the first pregnancy, were more likely to undergo intrapartum hospitalization admissions than multiparous women (Nethery et al., 2021). The maternal and infant mortality rate within the first week following the start of labor was 0.57 per 1,000 births (Nethery et al., 2021). Other negative consequences likewise had modest rates. As a result, the findings from the literature, along with the patients preferences, can be applied in practice by learning whether the woman is at higher risk of interventions based on the number of pregnancies.
However, an original study conducted by Homer and colleagues a few years prior with a bigger sample has different findings. According to the study, 93.6% of the 1,251,420 deliveries were scheduled in hospital labor rooms, compared to 5.7% at birthing facilities and 0.7% at home (Homer et al., 2019). Healthy labor and delivery probabilities were more than twice as high in planned birth centers and almost six times as high in intended home births compared to intended hospital births (Homer et al., 2019). Between the three scheduled birth locations, there were no statically meaningful variations in the frequency of intrapartum stillborns, early neonatal mortality, or late neonatal mortality (Homer et al., 2019). This contradicts the previous statements and yet it is noteworthy that the given study analysis sample data from ten years.
Finally, it is vital to mention the study by Howell, which outlines the rates of postnatal care. According to the study, severe postpartum morbidity affects a hundred women for every maternal death (Howell, 2018). Despite the fact that the postpartum period offers a chance to intervene and alter some trends, few low-income women consult a postpartum doctor (Howell, 2018). Absence from the postnatal appointment within the first 90 days is associated with a lack of prenatal care and delayed admission into antepartum care (Howell, 2018). Many women encounter obstacles, such as financial constraints, childcare issues, psychological discomfort, and knowledge gaps (Howell, 2018). As a result, the findings of this study pose an anticipated challenge and barriers that need to be overcome. The solution to such problems when working with patients is educating them on the possible issues that will result from a lack of proper postnatal care within the first three months.
As for utilizing the dynamic process of questioning, learning, and obtaining knowledge in the future as a lifelong learner, I would focus on applying information from the studies and research. As has been mentioned, one study found that many women are at risk of interventions and higher mortality due to the long distance from home to the hospital, and options should be discussed with the patient while paying attention to their preferences. Moreover, when it comes to questioning, it is vital to look at the patient history and how many pregnancies they had to determine the risk of interventions. Overall, the process of learning in the future will be determined by personal workplace experience and research.
References
Homer, C. S., Cheah, S. L., Rossiter, C., Dahlen, H. G., Ellwood, D., Foureur, M. J.,& & Scarf, V. L. (2019). Maternal and perinatal outcomes by planned place of birth in Australia 20002012: A linked population data study. BMJ Open, 9(10), 1-12. Web.
Howell E. A. (2018). Reducing disparities in severe maternal morbidity and mortality. Clinical Obstetrics and Gynecology, 61(2), 387399. Web.
Nethery, E., Schummers, L., Levine, A., Caughey, A. B., Souter, V., & Gordon, W. (2021). Birth outcomes for planned home and licensed freestanding birth center births in Washington State. Obstetrics and Gynecology, 138(5), 693-702. Web.
Reitsma, A., Simioni, J., Brunton, G., Kaufman, K., & Hutton, E. K. (2020). Maternal outcomes and birth interventions among women who begin labour intending to give birth at home compared to women of low obstetrical risk who intend to give birth in hospital: A systematic review and meta-analyses. EClinicalMedicine, 21, 1-10. Web.
Van der Kooy, J., Birnie, E., Denktas, S., Steegers, E. A., & Bonsel, G. J. (2017). Planned home compared with planned hospital births: mode of delivery and perinatal mortality rates, an observational study. BMC Pregnancy and Childbirth, 17(1), 1-11. Web.
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