Genesis

Research

Making decisions about your pregnancy and birth can be a stressful process as everyone seems to have different opinions. Genesis Clinic advocates a non-interventional approach to birth and we remain constantly vigilant of the latest medical research, to ensure that the care we offer is the best possible. That said, we always encourage moms and dads to do their own research. Be aware of looking for articles and sites that have been published in widely accepted medical forums rather than following opinion sites.

Birth outcomes of midwife assisted deliveries

Because free-standing Midwife Obstetric Units and midwife-led maternity care are still relatively new in South Africa, Genesis Clinic looked to international statistics to evaluate the safety of this model of care.

The Netherlands is known for its high home birth rates, with over 30% of Dutch women giving birth outside of hospitals. It thus seemed, in the course of researching the viability of the Genesis Clinic, like an appropriate place to start looking for statistics. Following are the Perinatal Mortality Rate by Birth Attendant and Place for the Netherlands:


research_graph_1

Many argue that statistics such as these are skewed as obstetricians would naturally be attending all the high risk women. In answer to that, are the following statistics from Britain, done according to the risk score of the mother. The chart indicates the perinatal mortality rate per 1 000 births recorded for 11 000 hospital births versus that recorded for 5 200 out-of-hospital, midwife assisted births.


research_graph_2


In 1991, British research statistician Tew teamed up with Dutch physician Sonya Damstra-Wijmenga, M.D. to publish statistics demonstrating that independent, non-nurse Dutch midwives, practicing in homes and hospitals, were associated with 10 times fewer perinatal deaths than Dutch obstetricians. Tew and Damstra-Wijmenga noted that high risk patient selection bias could only account for a small part of the obstetricians' ten-fold greater perinatal mortality rate.

In part as a result of Tew and Damstra-Wijmenga's work, a select committee of the British government was formed to survey the world literature regarding maternity care. The select committee had the following to say:
[We] must draw the conclusion that the policy of encouraging all women to give birth in hospitals cannot be justified on grounds of safety...[I]t is no longer acceptable that the pattern of maternity care provision should be driven by presumptions about the applicability of a medical model of care based upon unproven assertions...Hospitals are not the appropriate place to care for healthy women...We recommend that the Department of Health vigorously pursue the establishment of best practice models of team midwifery care...

"[A] 'medical model of care' should no longer drive the maternity service and women should be given unbiased information...including the option, previously denied to them, of having their babies at home..." [House of Commons Select Health Committee, Second Report 1992. Quoted in Department of Health (Britain). Changing Childbirth HMSO Publications Centre, P.O. Box 276, London, SW8 5DT.]


Research done in America has produced similar results. The conclusion drawn after a study of outcomes in birth centres by the Centre for Population and Family Health at Columbia University in New York states the following:
We studied 11 814 women admitted for labor and delivery to 84 free-standing birth centers in the United States and followed their course and that of their infants through delivery or transfer to a hospital and for at least four weeks thereafter. The women were at lower-than-average risk of a poor outcome of pregnancy.

There were no maternal deaths. The overall intrapartum and neonatal mortality rate was 1.3 per 1000 births. The rates of infant mortality and low Apgar scores were similar to those reported in large studies of low-risk hospital births. We conclude that birth centers offer a safe and acceptable alternative to hospital confinement for selected pregnant women.


These are just a select few excerpts from the myriad research available supporting and promoting the use of free-standing midwife obstetric units.