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PubMed1986

Do obstetric intranatal interventions make birth safer?

Impartial analyses of the evidence from official statistics, national surveys and specific studies consistently find that perinatal mortality is much higher when obstetric intranatal interventions are used, as in consultant hospitals, than when they are little used, as in unattached general practitioner maternity units and at home. The conclusion holds even after allowance has been made for the higher pre-delivery risk status of hospital births as a result of the booking and transfer policies. It holds even more strongly for births at high than at low predicted risk. It follows that the increased use of interventions, implied by increased hospitalization, could not have been the cause of the decline in the national perinatal mortality rate over the last 50 years and analysis of results by different methods confirms that the latter would have declined more in the absence of the former. Data are presented which point to the deleterious effect of interventions on the incidence of low birthweight and short gestation and their associated mortality. Also presented are data supporting the alternative explanation of the decline in perinatal mortality, namely the improvement in the health status of mothers built up over several generations. The organization of the maternity service stands indicted by the evidence. Despite the beliefs of those responsible, it has not promoted, and cannot promote, the objective of reducing perinatal mortality.

Birth Weight↗
PubMed1986

A comparison between the organization of obstetrics in Denmark and The Netherlands.

A comparison was made between two types of obstetric organization: total hospitalization as in Denmark, and a system that allows a choice between hospital and home delivery, provided there are no medical contra-indications, as in The Netherlands. Until the end of the 1950s, the current Dutch view prevailed in Denmark; Denmark changed its organization in the late 1960s and followed the international preference for total hospitalization. This change was not caused by disappointing obstetric results, nor was it the result of strong pressure from pregnant women. The change was associated with a considerable increase in instrumental deliveries. In both countries the perinatal mortality rate decreased continuously but in Denmark the improvement in early neonatal mortality was slightly faster. This difference may have occurred because of insufficient referral in The Netherlands of high-risk pregnancies and deliveries to the fully equipped obstetric departments. The Dutch acceptance of a high proportion of home-confinements is unlikely to be the explanation.

Delivery, Obstetric↗