Porod kod kuće-novo istraživanje u Australiji

Nekoliko zanimljivih pogleda na porod kod kuće iz Australije:


http://www.abc.net.au/news/stories/2....htm?site=news

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A study has found babies delivered during a home birth are seven times more likely to die from complications than during a planned hospital birth.
The study, published in the Medical Journal of Australia, compared all births in South Australia between 1991 and 2006.

The study's author, Professor Marc Keirse, says there was no difference in mortality rates overall, but the risk of babies suffering from a lack of oxygen during a home birth delivery was 27 per cent higher.

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I komentar ovog istraživanja:

http://www.mja.com.au/public/issues/...s11237_fm.html

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The outcome is that midwives can continue to provide care for women who have planned home births, but are required to provide full disclosure to their clients that they are not indemnified, and in return must provide data and participate in a safety and quality framework that will be overseen by the Victorian Department of Health. This should ensure a gradual accumulation of data (including statistics on outcomes such as maternal and perinatal morbidity) that can inform future policy direction, and also encourage adherence to proper clinical risk assessment and management to minimise preventable mortality and morbidity. Those who argue that planned home birth in Australia can be safe will have to show this on the basis of accumulated evidence before any further changes can be considered.
With time, the gulf between the politics and science of home birth in Australia should narrow, allowing health policymakers to focus on evidence-based decisions, rather than political ones.

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http://www.radionz.co.nz/news/storie...8/1247ec65d1dc

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Home births are associated with higher death rates than hospital births, according to research published in the Medical Journal of Australia .

The ABC reports the study examined home and hospital births in South Australia over a 15-year period to 2006.

The Australian Medical Association says it shows that deaths from home births were markedly more common than hospital births.

President Andrew Pesce says the study sends a strong signal to the government that any policy decisions on maternity care must be based on evidence.

Dr Pesce says the association does not support home births.

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http://www.ama.com.au/node/5273

New study confirms high risks of home births
17 January 2010 - 12:00pm

AMA President, Dr Andrew Pesce, said today that a new Australian study confirms the high safety risks and higher death rates associated with home births in Australia compared to hospital births.

The study of home and hospital births in South Australia between 1991 and 2006, published in the latest edition of the Medical Journal of Australia, shows that planned home births had a sevenfold higher risk of intrapartum death (occurring during delivery) and a 27-fold higher risk of death from intrapartum asphyxia than planned hospital births.

Dr Pesce said the study sends a strong signal to the Government that any policy decisions around maternity care must be evidence-based, not politically motivated.


“The safety of mothers and babies must come first in any debate about maternity care,” Dr Pesce said.
“The AMA supports women having choice when it comes to labour and childbirth, but they must also have access to all the evidence to ensure that their choice is an informed choice.

“The AMA does not support home birth because of the safety concerns for mother and baby, and this latest independent study backs our concerns.

“However, we do support expanded Medicare funding arrangements to improve patient access to midwife care within a quality framework that guarantees meaningful collaboration between doctors and midwives.

“Team-based care arrangements need to be in place throughout the pregnancy to ensure that there is obstetric, anaesthetic and paediatric care readily available to deal with unpredictable complications.

“Evidence shows that patients enjoy better health outcomes when they are treated in a model of care that provides coordinated, continuous, and comprehensive patient-centred care that is delivered by appropriately trained health professionals.

“Australia is one of the safest places in the world for mothers and babies.

“It is vital that we do not walk away from a safe system that has served the Australian community well for generations,” Dr Pesce said.

17 January 2010

CONTACT:

John Flannery 02 6270 5477 / 0419 494 761

Peter Jean 02 6270 5464 / 0427 209 753

Follow the AMA on Twitter:
http://twitter.com/amapresident

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Deaedi prvotno napisa

, but the risk of babies suffering from a lack of oxygen during a home birth delivery was 27 per cent higher.

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t[/quote]

uuu, ovo je stvarno visoki postotak. :shock:

Odogovor na studiju i objašnjenja "druge strane":
http://www.homebirthaustralia.org/

Samo meni se čini da je ovo i mali pohod australijske vlade i njihovog ministra na ukidanje kućnog poroda. Gubitak prava na izbor definitivno ne gledam kao na nešto pozitivno, što bi ova studija mogla izazvati, a kada se pročita "druga strana" ne čini se da je tako strašna, makar meni, je li.

Isto tako, jedna JAKO zanimljiva studija i objašnjenja koja je dokazala da kućni porodi nemaju veći rizik, ali koji su se obavljali u prisustvu educirane primalje. Bilo je i transfera, epiziotomije i drugih medicinskih intervnecija, pa i smrti beba

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No maternal deaths occurred. After we excluded four stillborns who died before labour but whose mothers still chose home birth, and three babies with fatal birth defects, five deaths were intrapartum and six occurred during the neonatal period (see box). This was a rate of 2.0 deaths per 1000 intended home births. The intrapartum and neonatal mortality was 1.7 deaths per 1000 low risk intended home births after planned breeches and twins (not considered low risk) were excluded.

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Medicinske intervencije:

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Compared with the relatively low risk hospital group, intended home births were associated with lower rates of electronic fetal monitoring (9.6% versus 84.3%), episiotomy (2.1% versus 33.0%), caesarean section (3.7% versus 19.0%), and vacuum extraction (0.6% versus 5.5%). The caesarean rate for intended home births was 8.3% among primiparous women and 1.6% among multiparous women.

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Isto tako, ova studija spominjen australijsku studiju koja je pokazala drugačije rezultate, tj. da ima veći rizik, ali koja kaže:

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The two largest contributors to the excess mortality were underestimation of the risks associated with post-term birth, twin pregnancy and breech presentation, and a lack of response to fetal distress.

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a studija je rađena '86-'90 godine.

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50 perinatal deaths occurred in 7002 planned home births in Australia during 1985-90: 7.1 per 1000 (95% confidence interval 5.2 to 9.1) according to Australian definitions and 6.4 per 1000 (4.6 to 8.3) according to World Health Organisation definitions.

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Osim australijske studije spominju i druge koje se mogu pročitati.

Mislim, uvijek imamo najmanje 2 struje, ali na nama je da odlučimo, ako imamo kvalitetan izbor... :)
Nije sve za svakoga...

Ovaj clanak govori o istrazivanju na 5 puta vecem uzorku i ima skroz druge rezultate.

Participants All 5418 women expecting to deliver in 2000 supported by midwives with a common certification and who planned to deliver at home when labour began.

Results 655 (12.1%) women who intended to deliver at home when labour began were transferred to hospital. Medical intervention rates included epidural (4.7%), episiotomy (2.1%), forceps (1.0%), vacuum extraction (0.6%), and caesarean section (3.7%); these rates were substantially lower than for low risk US women having hospital births. The intrapartum and neonatal mortality among women considered at low risk at start of labour, excluding deaths concerning life threatening congenital anomalies, was 1.7 deaths per 1000 planned home births, similar to risks in other studies of low risk home and hospital births in North America. No mothers died. No discrepancies were found for perinatal outcomes independently validated.

Samo da naglasim, nije umrla nijedna zena. Smrtnost novorodjencadi je 1,7 promila. Da mi je znati koje se to hrvatsko rodiliste moze podiciti takvim rezultatom.

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cvijeta73 prvotno napisa

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, but the risk of babies suffering from a lack of oxygen during a home birth delivery was 27 per cent higher.

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t

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uuu, ovo je stvarno visoki postotak. :shock:[/quote]

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The study's author, Professor Marc Keirse, says there was no difference in mortality rates overall, but the risk of babies suffering from a lack of oxygen during a home birth delivery was 27 per cent higher.

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Cijela rečenica zapravo ide ovako.
Zapravo mi nije sasvim jasno - ako ja to dobro prevodim, to bi značilo da stopa smrtnosti kućnog u odnosu na bolnički porod nije različita, ali je veći postotak djece koja umru zbog nedostatka kisika.
Tako da bi tu nedostajao podatak od čega su veći rizici pri bolničkom porodu.

Ako sam krivo razumjela, ispravite me...
Ja sam, kao i Maslačkica, za slobodu izbora :)
Moram skrušeno priznati da nisam isčitavala sve članke detaljno, bar za sad.

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pomikaki prvotno napisa

Ja sam, kao i Maslačkica, za slobodu izbora :)

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Slažem se. U tome je bit. Svatko neka procijeni sam, samo je bitno da se upozna sa pro i kontra stavovima.

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Deaedi prvotno napisa

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pomikaki prvotno napisa

Ja sam, kao i Maslačkica, za slobodu izbora :)

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Slažem se. U tome je bit. Svatko neka procijeni sam, samo je bitno da se upozna sa pro i kontra stavovima.

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Pa naravno.
Ovaj pdf i jeste za to :mrgreen:

Marta i ja pričamo o istom članku, tj. istraživanju, za MENE, jednom jako dobrom istraživanju koje je uključilo USA i Kanadu.

Pomikaki, ispravaljam te - jer kaže da: ne postoji razlika u stopi smrtnosti, ali rizik patnje manjka kisika tokom kućnog poroda je 27% viši.

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marta prvotno napisa

The intrapartum and neonatal mortality among women considered at low risk at start of labour, excluding deaths concerning life threatening congenital anomalies, was 1.7 deaths per 1000 planned home births, similar to risks in other studies of low risk home and hospital births in North America. No mothers died. No discrepancies were found for perinatal outcomes independently validated.[/i]

Samo da naglasim, nije umrla nijedna zena. Smrtnost novorodjencadi je 1,7 promila. Da mi je znati koje se to hrvatsko rodiliste moze podiciti takvim rezultatom.

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Da odgovorim i ja linkom - svako hrvatsko rodilište se može podičiti statistikom:
http://www.index.hr/vijesti/clanak/r...ta/316081.aspx

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marta prvotno napisa

[
Samo da naglasim, nije umrla nijedna zena. Smrtnost novorodjencadi je 1,7 promila. Da mi je znati koje se to hrvatsko rodiliste moze podiciti takvim rezultatom.

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ok, smrtnost nije povećana.

ova zadnja rečenica ti nikako nije na mjestu, čak i članak koji si linkala uspoređuje samo trudnice niskog rizika, s urednim trudnoćama. treba uzeti u obzir, da se žene na kućni porod uglavnom odlučuju s urednim trudnoćama, a u rodilišta dolaze SVE ostale. s razno raznim komplikacijama u trudnoći. ne znam da li se vodi statistika o smrtnosti novorođenčadi u hrvatskim rodilištima, majki s kompletno urednom trudnoćom. to bi trebalo usporediti.

ali, nije samo stvar u smrtnosti (koja, btw, u riječkom rodilištu iznosi 2,5 promila, malo reklame ne škodi :mrgreen: ).

što je s ovim povećanim rizikom od komplikacija uslijed manjka kisika na porodu?
to je taj postotak koji je prilično velik i alarmantan.

a što je s ovim postotkom?

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Results 655 (12.1%) women who intended to deliver at home when labour began were transferred to hospital.

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u koju statistiku su one uključene, kućnu ili bolničku?

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cvijeta73 prvotno napisa

a što je s ovim postotkom?

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Results 655 (12.1%) women who intended to deliver at home when labour began were transferred to hospital.

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u koju statistiku su one uključene, kućnu ili bolničku?

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Ja iskreno mislim da sve zavisi od studije, tj. u ovoj studiji su uključene, zar ne? I kaže da je 12,1% prije poroda prebačeno u bolnicu ili u toku, a 1,3% nakon poroda.
I mislim da definitivno oni ulaze i u bolničku statistiku, ali naravno, zavisi kako se provodi studija i šta istražuje itd. i da li će biti naglašeno da su to bili transferi.

I da, upravu si što se tiče bolnica i njihovih statistika. Ove statistike su prikazane za bolnice sa niskorizičnim trudnoćama, tj. očekivanim porodima sa niskim rizikom i s njima se upoređuju.
S tim da postoje žene koje znaju da im je dijete mrtvo ili ima manu nespojivu za životom i odluče roditi kući.

Jedna stvar koja je zanimljiva je ova, a koja je ustvari i pokrenula kućni porod su nepotrebne medicinske intervenicije i da je kućni porod siguran.
Po meni, studija je pokazala da je porod siguran, i isto tako da je veći broj intervencija u bolnicama - gore sam citirala.

Maslačkice, hvala na ispravku, sad mi je jasnije

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pomikaki prvotno napisa

Ja sam, kao i Maslačkica, za slobodu izbora :)

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Slažem se. U tome je bit. Svatko neka procijeni sam, samo je bitno da se upozna sa pro i kontra stavovima.

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Tako je, i meni je osobno u redu da se linkaju i ovakvi podaci.
Samo, moj problem je što se ja mogu samo do mile volje upoznavati sa pro i kontra stavovima, a sloboda izbora mi je jako ograničena.

http://www.poliklinika-harni.hr/teme...14&godina=2009

izvor:
http://www.google.com/search?hl=en&r...&aq=f&oq=&aqi=

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A study carried out in the Netherlands - where ten times as many women give birth at home as in the UK - found that with mothers deemed a low risk a home birth is as safe as being in hospital.

The Royal College of Midwives says a seismic shift is needed in the way maternity care is delivered in order to allow women who want to give birth at home, and who are at low risk of complications, to do so. By the end of this year all women who be able to choose a home birth if it is medically suitable for them, under Government policy.

Currently just three per cent of women in the UK give birth at home whereas in the Netherlands 30 per cent of mothers deliver at home.

Research, published in the British Journal of Obstetrics and Gynaecology, carried out on more than 500,000 low risk mothers showed there was no significant difference in deaths of babies or admission to neonatal intensive care units whether they were delivered at home or in hospital.

The analysis was on those who were looked after by midwives in the community and who gave birth between January 1, 2000 and December 31, 2006.

Experts here however cautioned against applying the results to the situation in the UK.

Professor Philip Steer, BJOG editor-in-chief said: "It must be noted that maternity services in the Netherlands are set up to meet the demand for home births, transport is good, and distances short if emergency transfer to hospital is needed.

"The same advantages are not available in all places in the UK, so the safety of home birth has to be considered in the context of the availability of local services."

Prof Steer also warned that mothers who opt for a home birth may be different from those wishing to give birth in hospital and this can affect the results as the women were not randomly allocated a home birth or hospital birth. Women who have a home birth tend to already have children and are older.

Louise Silverton, Deputy General Secretary of the Royal College of Midwives, said: "This is a major step forward in showing that home is as safe as hospital, for low risk women giving birth when support services are in place.

"However, to begin providing more homebirths there has to be a seismic shift in the way maternity services are organised.

"The NHS is simply not set up to meet the potential demand for homebirths, because we are still in a culture where the vast majority of births are in hospital. There also has to be a major increase in the number of midwives because they are the people who will be in the homes delivering the babies.

"I hope this research will be reassuring to women who may have concerns about home birth, and to critics who have questioned its safety."

The study, the largest of its kind so far, found that those who planned a home birth were likely to be older, have a medium to high socio-economic status and have had two or more children already.

Lead researcher Professor Simone Buitendijk, Head of the Child Health Programme at the Netherlands Organisation for Applied Scientific Research, (TNO) in Leiden said: "In our research, we studied more than half a million women in primary care and compared planned home births with planned hospital births. The number of babies that died or were admitted to a neonatal intensive care unit was the same in both groups, namely, seven per 1, 000. "We conclude that women can safely choose where they want to give birth, provided the maternity care system is well equipped for homebirths."

A similar study comparing planned home births and hospital births in the UK is underway.

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Don't blame it on home births
http://www.expatica.com/nl/health_fi...rths_14059.htm

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pomikaki prvotno napisa

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Deaedi prvotno napisa

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pomikaki prvotno napisa

Ja sam, kao i Maslačkica, za slobodu izbora :)

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Slažem se. U tome je bit. Svatko neka procijeni sam, samo je bitno da se upozna sa pro i kontra stavovima.

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Tako je, i meni je osobno u redu da se linkaju i ovakvi podaci.
Samo, moj problem je što se ja mogu samo do mile volje upoznavati sa pro i kontra stavovima, a sloboda izbora mi je jako ograničena.

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potpisujem
i ja sam za slobodu izbora (koju, nažalost, nemam) :/

ispričavam se za linkove, evo pravih:

http://www.telegraph.co.uk/health/he...-are-safe.html

http://www3.interscience.wiley.com/j...TRY=1&SRETRY=0

http://www.expatica.com/nl/news/loca...ies_51677.html



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umjesto

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Don't blame it on home births
http://www.expatica.com/nl/health_fi...rths_14059.htm

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ovo je link koji radi:
Don't blame it on home births

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mamma Juanita prvotno napisa

ovo je link koji radi:
Don't blame it on home births

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Nije mi baš jasno tko je autorica :? :

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Don't blame it on home births
The infant mortality rate in the Netherlands remains one of the highest in the European Union, but is this anything to do with home births? Amanda van Mulligen investigates.

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Amanda van Mulligen, British born, moved to The Netherlands in 2000 and runs The Writing Well, an English language writing and translation business. She is married to a Dutchman and has one son. Amanda writes about life as an expatriate in Holland as well as travel articles. For more information visit her website at www.TheWritingWell.eu

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Meni su draži stručni i educirani autoriteti, oko pitanja poroda više vjerujem liječniku nego prevoditeljici, ali svatko bira svoje "stručnjake".

ne kužim, kakva prevoditeljica?

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Research by The Netherlands Organisation for Applied Scientific Research (TNO) in Leiden also shows no connection between infant mortality and home births.

Grave in Certosa Bologna's cemetery © fantisola.comSimone Buitendijk, Professor of Maternal and Child Health at TNO says, “In our research, we studied more than half a million women in primary care and compared planned home births with planned hospital births. The number of babies that died or that were admitted to a neonatal intensive care unit was the same in both groups, namely, seven per 1, 000. We conclude that women can safely choose where they want to give birth, provided the maternity care system is well equipped for homebirths.”

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dakle radi se o stručnjacima i stručnjom istraživanju,
zašto onakve insinuacije o nestručnosti?

Pa autorica članka koji si linkala.

Jedno su autori clanka, tj. istrazivanja, a drugo novinari koji prenose rezultate istrazivanja.

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marta prvotno napisa

Jedno su autori clanka, tj. istrazivanja, a drugo novinari koji prenose rezultate istrazivanja.

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U tome je stvar, ovaj članak je pravi kupus svega i svačega, pomiješano sa stavovima novinarke i kako si je ona protumačila istraživanje.

onda zanemari članak ak ti je neuvjerljiv,
nek fokus bude na istraživanju