No description available.

A Thesis submitted to The University of Arizona College of Medicine - Phoenix in partial fulfillment of the requirements for the Degree of Doctor of Medicine. / Maternal and perinatal mortality remains significantly high in low‐income countries with over 800 deaths per day of women around childbirth. Greater than 90% of such deaths occur in low‐income countries. The concept of maternity waiting homes (MWH) was reintroduced to aid in decreasing maternal and perinatal mortality. Since the previous Cochrane Review in 2012 on maternity waiting homes, there have not been any published randomized controlled studies. Do observational studies on MWHs demonstrate decreased maternal and perinatal mortality in low‐income countries when compared with the standard of care? We searched for primary articles that reported maternal and perinatal deaths as major outcomes in studies who compared MWHs to other methods such as direct hospital admits, we also investigated cesarean delivery rates. Search engines used were: Cochrane Review, Medline and CINAHL. Meta‐analyses and forests plots were formulated using MedCalc Software. Systematic review was drafted using MOOSE guidelines for meta‐analysis and systematic reviews of observation. Seven articles met criteria for this study. The maternal mortality rate for MWH was 105/100,000 and 1,066/100,000 for non‐MWH, Relative Risk (RR) 0.145 (95% Confidence Interval (CI) 0.062 to 0.204). Perinatal mortality rate was 60/1,000 in MWH compared to 65/1,000, RR 0.782 (CI 0.602 to 1.120) in non‐MWH. Stillbirth rate was 18/1,000 in MWH and 184/1,000 in non‐MWH, RR 0.204 (CI 63.88 to 94.08). Neonatal mortality rates were 16/1,000 in MWH and 15/1,000 in non‐MWH, RR 0.862 (CI 0.392 to 1.628). Cesarean deliveries rate was 24/100 for MWH and 18/100 in non‐MWH, RR 1.229 (CI 1.226‐1.555). MHWs statistically decreased maternal death, stillbirths and increased cesarean delivery rates. Overall, the observation nature of the study designs introduces selection biases that may have altered the results of the studies. No randomized trials have been done to date. We suggest cluster‐randomized studies to further evaluate the effect of MWHs.

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Thesis (M.S.)--Boston University / PLEASE NOTE: Boston University Libraries did not receive an Authorization To Manage form for this thesis or dissertation. It is therefore not openly accessible, though it may be available by request. If you are the author or principal advisor of this work and would like to request open access for it, please contact us at open-help@bu.edu. Thank you. / 2031-01-01

This research investigated a new community-based model of continuity of care provided collaboratively by a small team of midwives and obstetricians (St George Outreach Maternity Project or STOMP). The study considered whether STOMP improved maternal and neonatal clinical outcomes, resulted in a better experience for women and could be implemented within the current resources of a public teaching hospital in Sydney, Australia. A randomised controlled trial using a Zelen design was used to compare the STOMP model with standard care. One thousand and eighty-nine women were randomly allocated to either the STOMP model or standard hospital-based care. The Zelen design was used to increase the participation of women from non-English speaking backgrounds and to reduce disappointment bias in women allocated to the control group. The results suggest that the model of community-based continuity of care is associated with a lower caesarean section rate, more positive experiences for women and costs less than standard care. There were no differences in the number of medical complications experienced in either group, but more women in the control group were admitted to hospital during the antenatal period. There were four perinatal deaths in each group. Women in the STOMP group reported a higher quality of antenatal care compared with the control group. Women in the STOMP group also reported that the community-based service was accessible and convenient with reduced waiting times for appointments. Women in the STOMP group were more likely to have received adequate information about labour, birth and the postnatal period and felt more 'in control' during labour compared with the control group. Women from both groups reported problems with postnatal care, particularly when provided in the hospital. The study also examined the impact of the STOMP model on women from Chinese and Arabic-speaking backgrounds. The STOMP model appeared to reduce the rate of elective and emergency caesarean section in Chinese-speaking women compared with English-speaking women. Small numbers precluded statistical analysis on these data so the results must be interpreted with caution. Women from Chinese-speaking backgrounds reported receiving insufficient information. The STOMP model improved the provision of information, however Chinese-speaking women still reported inferior experiences. There were also differences in the method of infant feeding. The results indicate that the model provides effective, cost efficient and satisfying maternity care. New models of maternity care can be implemented within current resources when organisations have a strong commitment to change.

No description available.

There is a paucity of research about the uptake and utilisation of antenatal care by pregnant adolescents in New Zealand. Media coverage, public perceptions and societal values often presume that adolescents when compared to other women, generally initiate antenatal care if at all and have adverse outcomes related to pregnancy, such as low birth weight and preterm deliveries compared to other woman. This research aims to assess the variations that may exist in the utilisation of and outcomes from antenatal care maternity services for adolescents compared to the pregnant adult population in Christchurch, between 1st July 2004 and the 30th June 2005.

No description available.

No description available.

This research investigated a new community-based model of continuity of care provided collaboratively by a small team of midwives and obstetricians (St George Outreach Maternity Project or STOMP). The study considered whether STOMP improved maternal and neonatal clinical outcomes, resulted in a better experience for women and could be implemented within the current resources of a public teaching hospital in Sydney, Australia. A randomised controlled trial using a Zelen design was used to compare the STOMP model with standard care. One thousand and eighty-nine women were randomly allocated to either the STOMP model or standard hospital-based care. The Zelen design was used to increase the participation of women from non-English speaking backgrounds and to reduce disappointment bias in women allocated to the control group. The results suggest that the model of community-based continuity of care is associated with a lower caesarean section rate, more positive experiences for women and costs less than standard care. There were no differences in the number of medical complications experienced in either group, but more women in the control group were admitted to hospital during the antenatal period. There were four perinatal deaths in each group. Women in the STOMP group reported a higher quality of antenatal care compared with the control group. Women in the STOMP group also reported that the community-based service was accessible and convenient with reduced waiting times for appointments. Women in the STOMP group were more likely to have received adequate information about labour, birth and the postnatal period and felt more 'in control' during labour compared with the control group. Women from both groups reported problems with postnatal care, particularly when provided in the hospital. The study also examined the impact of the STOMP model on women from Chinese and Arabic-speaking backgrounds. The STOMP model appeared to reduce the rate of elective and emergency caesarean section in Chinese-speaking women compared with English-speaking women. Small numbers precluded statistical analysis on these data so the results must be interpreted with caution. Women from Chinese-speaking backgrounds reported receiving insufficient information. The STOMP model improved the provision of information, however Chinese-speaking women still reported inferior experiences. There were also differences in the method of infant feeding. The results indicate that the model provides effective, cost efficient and satisfying maternity care. New models of maternity care can be implemented within current resources when organisations have a strong commitment to change.