Hemförlossningar i Sverige 1992-2005. Förlossningsutfall och kvinnors erfarenheter.Detta är den första nationella undersökningen av planerade hemförlossningar i Sverige. Istudierna har vi avsett att studera kvinnor som fött eller planerat att föda barn hemma underperioden 1/1 1992 till och med 30/6 2005.Kvinnor som födde barn hemma skiljde sig från kvinnor som födde barn på sjukhus i vissaavseenden (Studie I). Data från det svenska medicinska födelseregistret för perioden 1992 till2001, för 352 kvinnor som fött utanför sjukhus jämfördes med data från 1760 kvinnor som föttpå sjukhus. Kvinnorna som fött utanför sjukhus födde fler barn, hade högre utbildningsnivåmen en lägre sammanlagd familjeinkomst och de yrkesarbetade i mindre omfattning jämförtmed kvinnor som födde barn på sjukhus. Kvinnorna som fött barn utanför sjukhus var oftarefödda i ett annat europeiskt land än Sverige men mer sällan utanför Europa. Förekomsten avhemförlossningar i Sverige baserat på registerkod ”född utanför sjukhus” var 0.38 per tusenfödslar.Genom barnmorskor som bistår hemförlossningar, annonsering och via en intresseförening fördem som vill föda hemma, identifierades 757 kvinnor med sammanlagt 1045 planeradehemförlossningar under perioden 1/1 1992 till 30/6 2005. Av de tillfrågade kvinnorna svarade99 procent att de ville delta i studien. Data insamlades genom frågeformulär. Totalt 100 av detillfrågade kvinnorna med sammanlagt 141 planerade hemförlossningar återfanns inte i detmedicinska födelseregistret. Förekomsten av planerade hemförlossningar baserat på data förkvinnor som identifierats via hemförlossningsbarnmorskor och annonsering, var 0.95 per tusenfödslar. Förekomsten av planerade hemförlossningar baserat på registerdata för dessa kvinnorvar 0.85 per tusen födslar. Överföring till sjukhus under eller direkt efter förlossningen skeddevid 12.5 procent av de planerade hemförlossningarna (studie II). De vanligaste orsakerna tillöverföringen var långsam progress (46%) samt att barnmorskan inte kunde komma närförlossningen hade startat (14%). Var fjärde förstföderska avslutade sin planeradehemförlossning på sjukhus och den vanligaste orsaken för överföring bland förstföderskor varatt en annan barnmorska än den kvinnan besökt för vård under graviditeten kom för att biståförlossningen. Faktorer som påverkade överföring hos omföderskor var att tidigare hagenomgått kejsarsnitt och för både förstföderskor och omföderskor att graviditeten varöverburen.Data från det svenska medicinska födelseregistret jämfördes för 897 förlossningar identifieradegenom datainsamlingen till studie II och 11 341 sjukhusförlossningar (kontrollgrupp). Kriterietför urval av kontrollgruppen var enkelbörd i graviditetsvecka 37 - 42 samt att förlossningenstartat spontant. Kvinnor som planerat att föda hemma födde oftare spontant vaginalt och hademer sällan allvarliga bristningar i underlivet efter förlossningen (studie III). Risker i sambandmed valet av förlossningsplats hade övervägts av tre fjärdedelar av kvinnorna (studie IV).Genom egen förberedelse, samtal främst med sin partner och hemförlossningsbarnmorskan,hanterade kvinnorna tankar om att de själva eller deras barn skulle kunna skadas eller dö vidförlossningen. Kvinnorna undvek att diskutera risker med personal inom den konventionellavården.Konklusioner: I Sverige, under åren 1992 – 2005, planerade omkring 100 kvinnor att föda barni hemmet varje år. En fjärdedel av förstföderskorna avslutade sin planerade hemförlossning påsjukhus och den totala förekomsten av överföringar var 12,5 procent. Kvinnorna hade övervägtrisker med en hemförlossning men undvek att diskutera dem med personal inom sjukvården.Den neonatala mortaliteten bland nyfödda vid planerad hemförlossning var 2,2 per tusen inomfyra veckor efter förlossningen jämfört med 0,6 per tusen i sjukhusgruppen. Kvinnor somplanerade en hemförlossning hade oftare en spontan vaginal förlossning med färre allvarligabristningar i underlivet efter förlossningen jämfört med kvinnor som födde på sjukhus.

Coyote Midwives is a documentary film about the birth workers who are leading alternative maternity care and reproductive justice in the state of Illinois. This film examines the medicalization of labor and delivery, the patriarchal norms that constitute a threat to a birthing parent’s health, and the structure in place to ensure that birth remains exclusively physician-controlled. Coyote Midwives captures the energy, spirit, and empowering potential of birth, the negotiation and compromise of “professionalizing” midwives, and the networks of criminalized, black market, safe maternity care that persevere despite the illegalities.

Background: Historically, the focus of the UK and international research exploring planned home birth decision making has been largely focused on understanding the experiences of women who decide to birth at home. As a result of high-profile research that suggests that non-OU birth locations are safe for low risk women, there has been a recent shift in focus resulting in research studies that aim to increase the rates of planned home birth, or more often the rates of all non-obstetric unit birth within the UK. However, despite this increased level of attention, the rate of home birth remains stubbornly low. Whilst there is some research to indicate why this might be the case, research that sheds a new light on the issue, and that develops an evidence base for new interventions is required. This thesis illuminates the factors that need to be considered in order to increase women’s abilities to make an informed decision about planned birth. Methodology: A pragmatic approach, using mixed methods, was used to explore the current way that we offer planned home birth to maternity service users, and to ultimately make suggestions about how this could be improved. The following studies have been undertaken: Study 1: Initial exploratory study: The case notes of one hundred and sixty nine women, from one health board and who had planned to birth at home, were audited. Non-participant observation of birth planning meetings at thirty-six weeks gestation were undertaken with seven community midwife and low-risk women dyads. These were followed by individual semi-structured interviews with the participants. Study 2: Scoping review: Qualitative and quantitative research, and non-research based literature, were analysed to produce a qualitative review of planned home birth decision making. Study 3: Active offer of planned home birth concept analysis The findings of the initial exploratory study and the scoping review, in addition to active offer literature that is predominantly applied to support the provision of services within minority official languages, were used to create an active offer of planned home birth. Study 4: Workshop study testing the findings of the concept analysis Narrative based exercises were used to explore the concept analysis findings with twenty previous service users who had birthed at home, nine previous service users who had chosen an institutional birth, and fourteen community midwives. Findings: Women will either take a ‘passive’ or ‘active’ approach to the offer of planned home birth, with a passive approach likely where no motivation for an active approach has been provided. Where a woman takes a passive approach, her ability to make an informed decision about planned home birth will depend on an active offer being made by her midwife. This will be most effective when it is supported by a midwife’s employing organisation. The findings of this thesis suggest that a two stage active offer of planned home birth (AOPHB) process, consisting of ‘Creating the conditions’ and ‘Positive reinforcement’ stages, can be used to underpin the offer of planned home birth. Discussion: There has previously been minimal understanding of how to facilitate the home birth decision making process, and a passive offer is routinely provided to women in the UK. The proposed two-stage AOPHB process provides a structured way for midwives to underpin their offer to women, in order that an increased percentage of women are able to make an informed decision about home birth and/or decide to birth at home. Where midwives apply the AOPHB, women who may take a passive approach could be ‘activated’ to engage in home birth decision making. A pilot intervention has been drafted to implement the AOPHB within clinical practice. The intervention provides support for the implementation of the two-stage AOPHB process through the use of individual components focused on midwives and their employing organisation; student midwives; and women, and their significant others. Implications: This thesis has contributed to the developing knowledge base about planned home birth decision making. The application of active offer theory to the offer of planned home birth has been undertaken for the first time, and this has generated a new and useful perspective on this area of midwifery practice. The resultant two-stage AOPHB process has the potential for developing midwifery practice in terms of supporting midwives to understand and facilitate women’s decision making around home birth, providing a flexible tool that can be used in clinical practice. This is the first approach that has been developed with the aim of increasing the ability of women to make an informed decision about whether they wish to birth at home. Additionally, the pilot AOPHB intervention has implications around the understanding of how employing organisations can best support midwives in this aspect of their role, and developing how student midwives are educated about offering home birth to women.

The aims of this study were to describe the childbirth preferences of nulliparous women in early pregnancy and to develop a model of the predictors of those preferences. Participants were recruited with Facebook advertisements and data were collected from 344 women via online survey. Predictors were measured using the Utah Test for the Childbearing Year. Predictors of childbirth preferences (type of birth care provider, birth setting, mode of delivery, and use/avoidance of pain medication) were tested using structural equation modeling. Conventional content analysis was employed to analyze women’s reasons for selecting the type of provider and setting they expected for their delivery. Although the majority of respondents preferred physicians and hospital birth, the proportions of women who preferred midwifery care and planned home birth were higher than currently access those types of care in the U.S. More respondents preferred to use pain medication than to avoid it. Over 95% of respondents preferred vaginal delivery. Women who had an internal locus of control and perceived their childbearing role to be one of active participation were more likely than women who saw their role as a passive one to prefer midwifery care, home birth, vaginal delivery, and to avoid pain medication. Women who saw the provider’s role as dominant to their own were more likely to prefer physicians and hospital birth than those who viewed the provider’s role as a collaborative one. The more fearful/painful women expected birth to be, the more likely they were to prefer cesarean delivery.

BakgrundHemförlossningar är fortfarande vanligt förekommande internationellt och ofta enda alternativet för många kvinnor i låginkomstländer. Nederländerna är ett av få industrialiserade länder där planerade hemförlossningar fortfarande är norm för friska, gravida kvinnor. Forskning har visat att det är lika säkert för kvinnor med lågriskgraviditeter i Nederländerna att föda hemma som att föda på sjukhus. I dag är hemförlossningar i Sverige inte ett alternativ inom det officiella hälso- och sjukvårdssystemet. Om svenska kvinnor erbjuds fritt att välja var de skulle kunna tänkas föda, skulle hemförlossningarna vara 10 gånger fler. Kvinnor som väljer att föda hemma har en inställning till födandet som en naturlig process och att den kvinnliga kroppen har skapats för att kunna föda.SyfteSyftet med denna studie är att beskriva hur kvinnor hanterar värkarbetet vid en planerad förlossning i hemmet.MetodEn kvalitativ innehållsanalys av 118 slumpmässigt utvalda enkätsvar. Studien grundar sig på svaren på en öppen fråga, ur ett frågeformulär, riktad till kvinnor som fött eller planerade att föda i hemmet.ResultatI kvinnornas beskrivning av sin hemförlossning identifierades fyra huvudkategorier som beskriver hur kvinnorna hanterar värkarbetet vid planerad hemförlossning; Att vara kvar i vardagen och utföra vardagssysslor, genom fysisk och mental aktivitet, naturlig smärtlindring samt genom omgivande stöd. SlutsatsSlutsatsen är att kvinnorna stannar kvar i vardagen samtidigt som det sker ett mirakel och detta underlättar hanteringen av värkarbetet. Det finns ingen skiljelinje mellan graviditet och förlossning som det annars gör när kvinnorna föder på sjukhus.

Introduction: In Ontario, prior to 1994, planned home birth attended by midwives was a self-paid service. Since the introduction of regulated midwifery in 1994, home birth is a government-funded service, and uses common resources. As such, there is a need to examine the impact that choice of planned location of birth puts on scarce resources. To date, costs associated with planned place of birth in Ontario have not been evaluated. Objectives: The primary objective is to answer the question: Do planned midwifery-attended home births from the onset of labour cost the Ontario health care system more or less than planned midwifery-attended hospital births from the onset of labour among a comparable low-risk cohort of women? Specifically, this analysis examines the cost of midwifery intrapartum care, from the onset of labour until hospital discharge or the first two days after delivery. Methods: This cost-analysis used a third-party payer perspective (health services costs) to analyze data from the Ontario Midwifery Program, which included 12, 886 midwife-attended births that occurred between April 1, 2003 and March 31, 2006. Three main sources of information were used to determine unit cost and health care utilization: the Ontario Midwifery Program data (2003-2006); data from the Ontario Case Costing Initiative; and the 2010 Schedule of Benefits for Physician Services. Data was analyzed using an intention to treat approach, i.e. based on planned rather than actual location of delivery. Results: Hospital birth is more expensive than planned home-birth. Results were significant with a P value =< .001. The median cost from the onset of labour was $995.95 (IQR $995.95 to $995.95) for planned home birth compared to $2118.12 (IQR $1467.12 to $3610.00) for planned hospital birth. Conclusions: Home birth, a choice that women in Ontario will continue to choose, does not result in costing the Ontario health care system more money. / Thesis / Master of Science (MSc) / This thesis answers the question: Do midwifery-attended planned home births cost the Ontario health care system more or less than midwifery-attended planned hospital births? This thesis examined midwifery-attended births that occurred in Ontario between April 1, 2003 and March 31, 2006 and associated costs that were incurred for both the mother and the baby from the onset of labour until two days following the birth. Since 1994 when midwifery was legislated in Ontario, registered midwives have been providing care to women in both home and hospital settings. While there is general consensus within the midwifery community that home births do not cost the health care system more money, a thorough analysis of costs incurred by midwifery-attended births has not been meaningfully analyzed. Midwifery is the only group of health care professionals providing maternity care that is increasing in size. Given the shortage and the current crisis of maternity care providers, the number of midwives in this province is likely to continue growing. At the same time, a cost analysis of the resources consumed through the provision of maternity care – both at home and at hospital- has not been conducted. This study provides key stakeholders with information regarding resources used and needed and the costs associated with these resources so that resource allocation and planning can be conducted in a responsive manner.

This thesis deals with home births and legal issues related to this topic. There is no specific regulation of home births in the Czech law, but it's possible to use Czech legislation for the interpretation of this issue, especially the legislation of medical law, civil law and criminal law. The issue of home births is recently very actual topic, which can be proven by the current extensive jurisprudence of the Czech and foreign courts, which belongs by the way to major sources of this thesis. In addition to describing the situation in the Czech Republic, I tried to point out some differences between the Czech and foreign law, I tried to outline some changes in the new Czech Civil Code and I also tried to provide some reflections on future trends in the issue of home births in the Czech Republic. The aim of my thesis was to highlight the conflicts of the guaranteed rights contained in the supreme law of which frequent disputes of society are going on, and to provide a possible solution of this situation. The issue of home births include the conflict between the right to protection of life and health, and the right to private and family life, both guaranteed by constitutional law. The right of privacy includes the right of women to freely choose the place of birth for their children, including the...

Bakgrund: Endast ett fåtal kvinnor i Norden väljer en planerad hemförlossning. I Sverige har en studie gjorts för att undersöka vilka karaktärsdrag som går att urskilja hos dessa kvinnor men liknande studier saknas för Norden. Syfte: Syftet med denna studie var att beskriva vad som är karaktäristika för kvinnor i Norden som väljer en planerad hemförlossning samt jämföra karaktäristika hos kvinnor i Sverige med kvinnor från tre andra nordiska länder. Metod: Studien är en retrospektiv tvärsnittsstudie med kvantitativ ansats. Materialet är insamlat mellan 2009-2011 inom ramen för forskningsnätverket ”Nordic Homebirth” via enkätformulär på internetsidan www.nordichomebirth.com. Icke-parametriska analyser genomfördes med hjälp av Chitvå-test. Resultat: Totalt svarade 778 kvinnor på enkäten. Kvinnorna i Sverige var i genomsnitt två år äldre och i högre grad omföderskor och sammanboende/gifta. Fler kvinnor i Norden var ensamstående/ej sammanboende jämfört med de svenska kvinnorna. Ingen skillnad i utbildningsnivå fanns mellan kvinnorna i Sverige och Norden. Slutsats: Skillnader i karaktäristika för kvinnor som väljer en planerad hemförlossning i Norden finns avseende ålder, paritet, civilstånd och ursprungsland. Bättre registrering av planerade hemförlossningar behövs för att kunna göra säkrare undersökningar av denna grupp. Nyckelord: planerad hemförlossning, karaktäristika, kvinnor, Sverige, Norden

The purpose of this study was to determine whether the wives' perceptions of personal control over the process of childbirth were related to couples' choices and utilization of three birthing alternatives (home birth, unmedicated hospital birth, and medicated hospital birth). The wives' perceived control over the childbirth process was expected to vary inversely with the level of medical intervention in the birthing alternative chosen. The home birth mothers were expected to perceive themselves as having more control over childbirth than were the unmedicated hospital group mothers, and the unmedicated hospital group mothers more than the medicated hospital group mothers. The husbands' perception of their wives' perceived control in childbirth and their participation was also measured.

Thesis title: CRIMINAL LIABILITY OF PHYSICIANS IN GYNECOLOGY AND OBSTETRICS The purpose of my diploma thesis is to analyse the issue of criminal liability of physicians, especially physicians in Gynecology and Obstetrics. The thesis is divided into five main chapters and many subchapters. The first chapter serves as an introduction to the legal liability in general. I mention the categories of liability- civil and labour liability are just noticed in this task, while administrative and disciplinary liability are discussed and defined. The aim is to compare these liability in healthcare and emphasize the ultima ratio principle of criminal liability. Chapter Two defines relevant concepts of medical law. This chapter deals with the concept of acting lege artis, acting non lege artis, informed consent of patient and advance directives. These concepts are demonstrated on examples from practice and related jurisprudence. I also define the specilization of Gynecology and Obstetrics and its legislation. The third chapter explains basic terms and concepts connected with criminal liability and define the necessary conditions and circumstances for physicians to commit a crime. The second section of this chapter focuses on circumstances under which some normally unlawful acting might not be considered illegal....