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Objective: To compare childbirth outcomes of women prospectively randomized to receive early labour assessment and support either through a home visit or by telephone triage., Methods: Women in early labour, upon seeking prior telephone advice on whether or not they were ready to be admitted to BC Women's Hospital (as was standard hospital practice), were voluntarily randomized to receive either a home visit by an obstetrical nurse or telephone triage., Results: One hundred seventeen women were randomized to receive home care and 120 to receive telephone triage. Significantly fewer women in the home care group arrived at hospital in the latent stage of labour, compared to women in the telephone triage group (odds ratio [OR], 0.37; 95% confidence interval [CI], 0.19-0.72). Significantly fewer women in the home care group received narcotics (OR, 0.55; 95% CI, 0.32-0.96). Differences observed in use of epidural analgesia (OR, 0.64; 95% CI, 0.36-1.16) were not statistically significant. Newborns in the home care group were significantly less likely to be admitted to a level II observation nursery (OR, 0.13; 95% CI, 0.03-0.60). More women in the home care group would recommend this type of care to a friend (P = 0.001)., Conclusion: Our findings suggest an association of early labour assessment at home with both admission to hospital in the active phase of labour and reduction in use of analgesia during labour. Early labour support at home was associated with reduced rates of admission of neonates to a level II observation nursery, possibly secondary to reduced exposure to analgesics. Early labour care at home by hospital-based obstetrical nurses is safe and acceptable to women, and may offer advantages in terms of reduced interventions and more vigorous neonates.

Objectives: The purpose of this study was to measure the prevalence of exposure to intimate partner violence during pregnancy and to determine whether such exposure is associated with adverse pregnancy outcomes., Study Design: We measured the prevalence of exposure to intimate partner violence and fear of a partner during pregnancy among 4750 residents of Vancouver, British Columbia, who gave birth between January 1999 and December 2000. We undertook a multivariate analysis to examine the associations with second- or third-trimester hemorrhage, preterm labor and delivery, intrauterine growth restriction, and perinatal death., Results: We report a prevalence rate of 1.2% for exposure to physical violence by an intimate partner during pregnancy and 1.5% for fear of a partner. Physical violence was associated with an increased risk of antepartum hemorrhage (adjusted odds ratio [OR]: 3.79, 95% CI 1.38-10.40), intrauterine growth restriction (OR: 3.06, 95% CI 1.02-9.14), and perinatal death (OR: 8.06, 95% CI 1.42-45.63). Fear of a partner in the absence of physical violence was not associated with an elevated risk of adverse pregnancy outcomes., Conclusion: Our study confirms prior work reporting an association of physical abuse during pregnancy with intrauterine growth retardation and, in addition, reports an association with antepartum hemorrhage and perinatal death.

Midwifery emerged as a self-regulated profession in British Columbia in the context of a 2-year demonstration project beginning in 1998. The project evaluated accountability among midwives, defined as the provision of safe and appropriate care and maintenance of standards of communication set by the College of Midwives of British Columbia. Adherence to protocols was measured by using documentation designed specifically for the Home Birth Demonstration Project. Hospital and transport records for selected clients were reviewed by an expert committee. Outcomes among Home Birth Demonstration Project clients were compared with outcomes among women eligible for home birth but planning to deliver in hospital. Adherence to clinical and communication protocols was 96% or higher. Planned home birth was not associated with an increase in risk but prevalence of adverse outcomes was too low to be studied with precision. Recommendations of an expert review committee have been implemented or are under review. Midwives have demonstrated a high degree of compliance with reporting requirements and protocols. Comparisons of birth outcomes of planned home versus hospital births, while supporting home birth as a choice for women, were limited in scope and require ongoing study. Integration of home birth has been a dynamic process with guidelines and policy continuing to evolve.

Background: The choice to give birth at home with a regulated midwife in attendance became available to expectant women in British Columbia in 1998. The purpose of this study was to evaluate the safety of home birth by comparing perinatal outcomes for planned home births attended by regulated midwives with those for planned hospital births., Methods: We compared the outcomes of 862 planned home births attended by midwives with those of planned hospital births attended by either midwives (n = 571) or physicians (n = 743). Comparison subjects who were similar in their obstetric risk status were selected from hospitals in which the midwives who were conducting the home births had hospital privileges. Our study population included all home births that occurred between Jan. 1, 1998, and Dec. 31, 1999., Results: Women who gave birth at home attended by a midwife had fewer procedures during labour compared with women who gave birth in hospital attended by a physician. After adjustment for maternal age, lone parent status, income quintile, use of any versus no substances and parity, women in the home birth group were less likely to have epidural analgesia (odds ratio 0.20, 95% confidence interval [CI] 0.14-0.27), be induced, have their labours augmented with oxytocin or prostaglandins, or have an episiotomy. Comparison of home births with hospital births attended by a midwife showed very similar and equally significant differences. The adjusted odds ratio for cesarean section in the home birth group compared with physician-attended hospital births was 0.3 (95% CI 0.22-0.43). Rates of perinatal mortality, 5-minute Apgar scores, meconium aspiration syndrome or need for transfer to a different hospital for specialized newborn care were very similar for the home birth group and for births in hospital attended by a physician. The adjusted odds ratio for Apgar scores lower than 7 at 5 minutes in the home birth group compared with physician-attended hospital births was 0.84 (95% CI 0.32-2.19)., Interpretation: There was no increased maternal or neonatal risk associated with planned home birth under the care of a regulated midwife. The rates of some adverse outcomes were too low for us to draw statistical comparisons, and ongoing evaluation of home birth is warranted.