A Comparative Study of Home and Hospital Births, Scientific and Normative Values and their Effects

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The integration of technology into birth services has been seen as an appropriate intervention, yet the common use of forceps and anaesthesia in the decade 1920 -1930 predated the use of randomised control trials to evaluate these procedures. There are indications that a number of measures such as living standards and health education, contributed to the lowering of infant and neonatal mortality rates. In this study, data on 51 homebirths and 509 hospital births from the NSW Maternal/Perinatal Statistics Collection are used to compare the outcomes of a cohort of women matched for risk status giving birth at home and in hospital. The analysis shows that there was significantly more morbidity for primiparous women* when Level 3 teaching hospitals were included in the analysis; ie. morbidity in the hospital births decreased when Level 3 teaching hospitals were excluded from the analysis. There were no significant differences in morbidity for multiparous women.** Further analysis of more recent data from the same source indicated a wide range of morbidity among hospitals from 53.2% to 82.5% for low-risk primiparous women. Whether or not a new comparative study of home and hospital births might produce statistically significant results would depend on which hospitals were chosen in the comparative group. Some caution should be used in interpreting the results as the reliability of the data has not yet been ascertained. This would require a comparison of the computerised records with hospital and homebirth recording methods. The conclusion drawn from this analysis indicates that normative variables (commonly held beliefs and values) as well as scientific variables should be considered in the evaluation of birth services. * Primiparous women are women giving birth for the first time. ** Multiparous women have had a previous birth.
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Boland, Cathy
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