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INTRODUCTION Pregnancy is a wonderful experience for many women all around the world.

Bringing a new life into the world is an amazing thing. It is important to find a way to have your baby in a way that is best for the mother and child. Child birth can take a lot of stress on the mother's body. Women have even been known to have died from it. This is why it is crucial to find the method that you think will work for you to lessen the already slim chance of that happening. Birthing should be as easy and relaxed as possible. Childbirth (also called labor, birth, partus or parturition) is the culmination of a human pregnancy or gestation period with the expulsion of one or more

newborn infants from a woman's uterus. The process of normal human childbirth is categorized in three stages of labour: the shortening and dilation of the cervix, descent and birth of the infant, and birth of the placenta. (The Columbia Encyclopedia, Sixth Edition Copyright 2006 Columbia University Press). This is considered as the completion of a ladys womanhood. And a lot of women prepare for this miracle of life. Expectant parents must be able to prepare properly for this to ensure the safety and well being of the baby. The following would be some of the things they have to complete/consider in preparation for the childs delivery: Shop for baby things, prepare your hospital bags, decide your birthing option, explore the birthing site, prepare yourself physically and emotionally, manage domestic matters, start a hobby and choose your baby's name and decide on how to announce the great news. One of the first and most important decisions expectant parents face is where they will deliver their baby. Having a baby is like having a moment of immense strength &

passion. Where and how you choose to give birth can either enhance the life experience or diminish it. While for many its more of an issue of which hospital they prefer or with which their doctor is affiliated, for others, its whether theyd prefer a natural home birth with the assistance of a midwife, and if the option is safe for the mother and the baby (1). 1

The place of delivery is the very crucial factor which affects the health and well-being of the mother and newborn (2). Dr. Jay DiLeo, BabyZones expert OB GYN, father of eight, author of The Anxious Parents Guide to Pregnancy discourages couples from opting for a home birth, stating that while home birthing after a normal pregnancy is relatively safe, on an

individual basis, the statistics arent reassuring if youre that one person out of hundreds or thousands who has complications.(1) James Henderson, a lawyer, home birthing father, and president of the Massachusetts Friends of Midwives, challenges Dr. Dileos position and believes that homebirthing after a normal pregnancy is as safe as if not safer than laboring and delivering in a hospital setting.(1) It is strange how medical practices vary when it comes to childbirth. Many developed countries favor hospital birth but in a few countries, delivery at home attended by a registered midwife or nurse has been the norm for quite a while (3).

STATEMENT OF THE PROBLEM: In general, the purpose of this study is to evaluate the percentage of women or expected parents who would choose Home Birth over Hospital Birth. Specifically, this study also intended to answer the ff questions: 1. What method of child birth is preferred by most women in Cagayan?

2. What are the factors that affect/s their choice of child birth?

SIGNIFICANCE OF THE STUDY: This study would provide information to expectant mothers on which birth method to be used. This will provide both the advantages and disadvantages of two main birthing methods: Home Birth and Hospital Birth. This study could also be a big help to midwives and/or nurses and other medical practitioners who shall be attending homebirths in the future. It could serve as a basis on how the above-mentioned people could improve their ways in homebirth which could further decrease, if not eliminate, fatality on both the mother and the baby. This could provide motivation for hospitals to evaluate their current practices and identify aspects which needs improvement, and begin to implement protocols that better reflect current evidence-based research and womens desired preferences.

RELATED LITERATURE: There are several factors that contribute to the decision of the parents in choosing where to deliver their babies. Some of these are safety, socioeconomical status, different interventions made during the labor and delivery and basic health service accessibility. In the study conducted by Jansenn, P. et al entitled Outcomes of planned home birth with registered midwife versus planned hospital birth with midwife or physician, they found out that planned home birth attended by a registered midwife was associated with very low and comparable rates of perinatal death and reduced rates of obstetric interventions and adverse maternal outcomes compared with planned Hospital birth attended by a midwife or physician. The population rate of less than 1 perinatal death per 1000 births may serve as a benchmark to other jurisdictions as they evaluate their home-birth programs. On the other hand, Wax, J. et al conducted a study entitled Maternal and newborn outcomes in planned home birth vs planned hospital births: a metaanalysis states that planned home births were associated with fewer maternal interventions including epidural analgesia, electronic fetal heart rate monitoring, episiotomy, and operative delivery. These women were less likely to experience lacerations, hemorrhage, and infections. Neonatal outcomes of planned home births revealed less frequent prematurity, low birthweight, and assisted newborn ventilation. Although planned home and hospital births exhibited similar perinatal mortality rates, planned home births were associated with signicantly elevated neonatal mortality rates. This metaanalysis shows that planned home compared to planned hospital births are associated with significantly less maternal and newborn medical intervention and

morbidity particularly among selected low-risk women cared for by highly trained and regulated midwives who are integrated into the health care system. These ndings are notable in that our analysis by planned delivery site conrms many of the observations of a recent cohort study evaluating outcomes by actual delivery location. At rst glance, these results are not surprising for several reasons. Many women choose home birth, at least in part to avoid pharmacologic analgesia and medical technology. Most women considered to be home birth candidates exhibit low obstetric risk and should therefore anticipate more favorable outcomes than women choosing or requiring a planned hospital delivery. Finally, most home births are attended by midwives, a group demonstrating distinctly different obstetric practice patterns from physicians performing most in-hospital deliveries. The research entitled Womens perceptions of homebirths in two rural medical districts in Burkina Faso: a qualitative study of Some, T. et al shows that homebirths are motivated by distance and road conditions to reach health facilities, lack of money to pay for care and drugs, easy labour and sudden childbirth, tradition and also bad treatment administered by health providers to some women in health facilities. Also, in both districts, the rate of education is low and girls particularly do not always have the luck to go to school. The consequence is their low status in the society and the lack of power for decision-making to use health facilities when they needed. A study carried out in Nepal, had shown that poor education and multiparity increased the risk of home delivery. This situation could be similar to our context; around 90% of our respondents had no education level or at most the first six years at school in our education system. This could be a handicap for a good management of the pregnancy and the childbirth. In these circumstances, they do not understand very well the necessity to use a health facility for skilled care for herself and her baby.

The research of Janssen, P. et al entitled Outcomes of planned home birth with registered midwife versus planned hospital birth with midwife or physician showed that decision to plan a birth attended by a registered midwife at home versus in hospital was associated with very low and comparable rates of perinatal death. Women who planned a home birth were at reduced risk of all obstetric interventions assessed and were at similar or reduced risk of adverse maternal outcomes compared with women who planned to give birth in hospital accompanied by a midwife or physician. Newborns whose mothers planned a home birth were at similar or reduced risk of fetal and neonatal morbidity compared with newborns whose mothers planned a hospital birth, except for admission to hospital (or readmission if born in hospital), which was more likely compared with newborns Our study showed that planned home birth attended by a registered midwife was associated with very low and comparable rates of perinatal death and reduced rates of obstetric interventions and adverse maternal outcomes compared with planned hospital birth attended by a midwife or physician. Our population rate of less than 1 perinatal death per 1000 births may serve as a benchmark to other jurisdictions as they evaluate their home-birth programs.

Research Paradigm/Research Simulacrum

Respondent s culture, belief and preference

Safety Less medical intervention Basic health services accessibility Socioeconomic status

HOME BIRTH

HOSPITAL BIRTH

Based on the diagram above, there are certain factors that needs to be considered by expectant mothers to be able to choose which birthing method to be done.

METHODS: This was a qualitative study to investigate the preference of women in Cagayan about the place of delivery (hospital or home) and factors affecting this preference.. The studied women were those who are pregnant and who had delivered a baby. They were drawn from Dassun Solana, Cagayan; Annafunan, Tuguegarao City and Cataggaman, Tuguegarao City. The study included 150 women. A special unvalidated questionnaire form was designed by the researchers to obtain information on sociodemographic characteristics of the women, the distance between the place of residence and nearest official delivery facility, parity, place of delivery of present, first, previous and future child when applicable and reasons behind choosing home or hospital delivery. Data were collected through a questionnaire. The women gave informed verbal consent to participate and there were no refusals.

RESULTS Table 1. Demographic Data of women choosing Home Birth Variable Frequency Civil Status Married 88 Single 0 Religion Roman Catholic Born Again 87 1 Percentage 100 0 98.90% 1.10%

Christian Fathers 1.Elementary Undergraduate Educational 2.Elementary Graduate Background 3.High School Undergraduate 4.High School Graduate 5.College Undergraduate 6.College Graduate Mothers 1.Elementary Undergraduate Educational 2.Elementary Graduate Attainment 3.High School Undergraduate 4.High School Graduate 5.College Undergraduate 6.College Graduate Health Care 1. Mother 2. Father Decision Maker 3. Both 4. With Relatives

8 8 6 24 21 21 3 11 9 20 19 26 6 1 73 8

9.10% 9.10% 6.80% 27.30% 23.90% 23.90% 3.40% 12.50% 10.20% 22.70% 21.60% 29.50% 6.80% 1.10% 83.00% 9.10%

This table shows the demographic data of women who chose to have home birth. All the 88 respondents who chose Home Birth are married. 98.90% of them are Roman Catholic while the remaining 1. 10% are Born Again Christians. Majority of the women and their husband are High School Graduate with 22.70% and 27.30% respectively. Majority observe equal decision making for both the father and the mother. Table 2. Demographic Data of women choosing Hospital Birth. Variable Groups Frequency Percentage Civil Status Married 60 96.80% Single Religion Roman Catholic 2 61 3.20% 98.40% 9

Born Again 1 Christian 1.Elementary Undergraduate 2.Elementary Graduate 3.High School Undergraduate 4.High School Graduate 5.College Undergraduate 6.College Graduate 1.Elementary Undergraduate 2.Elementary Graduate 3.High School Undergraduate 4.High School Graduate 5.College Undergraduate 6.College Graduate 1. Mother 2. Father 3. Both 4. With Relatives 1 5 4 11 17 24 3 11 9 20 19 23 7 2 46 7 1.60% 1.60% 8.10% 6.50% 17.70% 27.40% 38.70% 3.40% 12.50% 10.20% 22.70% 21.60% 37.10% 11.30% 3.20% 74.20% 11.30%

Fathers Educational Background

Mothers Educational Attainment

Health Care Decision Maker

This table shows the demographic data of women who chose to have hospitalbirth. Majority of them are married while 3.20%of them are single. 61 (98.40%) are Roman Catholic while the remaining 1 (1.60%) are Born Again Christian. Majority of the women and their husband are College Graduate with 37.10% and 38.70% respectively. Majority observe equal decision making for both the father and the mother. Table 3. Factors that affect the womens decision in choosing the place of delivery. HOME BIRTH HOSPITAL BIRTH Variable Group Frequency Percentage Frequency Percentage
Importance of Fathers Participation during birth Partners Attendance

Yes No Yes No

79 9
82 6

89.88%

56 6 56 6

90.33% 9.67% 90.33% 9.67%

10.22
93.19% 6.81%

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Beliefs or customs prohibiting physical activity during pregnancy, birth and the postpartum period Plan to observe the beliefs or customs Cleanliness of the setting Safe and better outcome Comfortable birthing place

Yes

73

82.96%

51

82.25%

No

15

17.04%

11

17.75%

Yes No Yes No Yes No Yes No Yes No

75 13 76 12 70 18 80 8 77 11 49 39 76 12 58 30 86 2 30 58 54 34

85.23% 14.77% 86.37% 13.63% 79.55% 20.45% 90.91% 9.09% 87.50% 12.50% 55.68% 44.32% 86.37% 13.63% 65.90% 34.10% 97.73% 2.27% 34.09% 65.91% 61.37% 38.63%

42 20 55 7 61 1 56 6 54 8 62 0 61 1 59 3 47 15 47 15

67.75% 32.25% 88.70% 11.30% 98.39% 1.61% 90.33% 9.67% 87.10% 12.90% 100% 0% 98.39% 1.61% 95.16% 4.84% 75.80% 24.20% 75.80% 24.20%

Privacy

Babys betterment Assisted by preferred Health Care Provider Accessibility of things Family experience Fear in hospital doctors Hindrance of distance to the

Yes No Yes No Yes No Yes No Yes No Yes No

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hospital Importance of social support Intervention Free History of fast labor Unplanned home birth

Yes No Yes No Yes No Yes No Yes No Yes No

74 14 73 15 63 25 46 42 86 2

84.10% 15.90% 82.96% 17.04% 71.60% 28.40% 52.28% 47.72% 97.73% 2.27% 42 67.75%

Economical Does not think distance as hindrance to go to the hospital High risk pregnancy Better Cared off Meets the standard of care Submit self even with medical intervention

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32.25%

Yes No Yes No Yes No Yes No

58 4 58 4 55 7 62

93.55% 6.45% 93.55% 6.45% 88.70% 11.30% 100%

0%

In terms of the importance of the presence of the partner during birth and willingness of their husband to witness their birthing, almost 90% of them answered yes.

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At least 80% of them have beliefs and customs during birth and as they were asked if they are willing to perform their cultural beliefs only 85.23% of mothers gave birth at home agrees while on mothers gave birth at hospital have only 67.75% As for the location, they find it clean in their chosen setting of birth, they are comfortable in their place and can get enough privacy, both home and hospital birth have almost equal percentage of people who agreed that they were able to meet these, but for safety and better outcome of the delivery, only 79.55%of the home birth can acquire this, while it is higher in hospital birth which is 98.39%. On the accessibility of the things needed, 65.90% said yes on the home birth, while it is way higher answered yes on the hospital birth which is 95.16%. Talking about the babys betterment during delivery mothers who undergo hospital birth, they all agreed that they will obtain this, while on hospital birth there are only 55.68%agreed, which is very low compared to hospital birth. Both of them also got high positive answer when in terms of the having the chosen health care professional that will assist them during the procedure. For the reason of choosing hospital and home birth due to family experience, 97.73 said yes while on the other hand only 75.80 only agrees. There is only 34.09% home delivery answered yes when they are asked if they have fear on hospital doctors while on hospital birth they have higher percentage which is 75.80%. For the question if distance is hindrance for the home birth to go to the hospital only 38.63% answered no, while for the hospital birth 67.75% think distance is not a hindrance to them to submit themselves to the hospital. We also got high percentage of the respondents who agrees that there is Importance of social support, intervention free, history of fast labor, unplanned home birth and economical that is why they submit themselves to Home birth. Most of the respondents on the hospital birth got high percentage that they choose hospital delivery because they have high risk pregnancy, better cared off, they also know that hospital meets the standard of care they want and all of them submit self even with medical intervention. 13

DISCUSSION: Statistics show that home birth is as safe or safer than hospital birth for low-risk women with adequate prenatal care and a qualified attendant. At home, a woman can labor and birth in privacy and comfort of the familiar surroundings of her own home, surrounded by loved ones, in whatever positions and attire she finds most comfortable. The laboring woman maintains control over everything impacting her labor and birth. Meeting her needs is the only focus of all those present. Nothing is done without consent. Labor is allowed to progress normally, without interference and unnecessary interventions. Studies show that the risk of infection is reduced for both the mother and baby. During labor the woman is encouraged to eat, drink, walk, change position, make noise, shower, bathe, etc. Care-givers are invited guests in the birthing womans home. She can have anyone she desires present: family, friends, children, etc. Her care providers (midwife and birth assistant) do not go home because their shifts have ended. The birthing mother doesnt have to worry about when to go to the hospital since her care providers come to her. Continuous one-on-one care is given by the midwife, providing ongoing assessment of the babys and mothers condition throughout the birth process and postpartum period. Her care provider knows her well and she knows her care provider. They have established a trust relationship. Women are supported throughout the hard work of labor, and empowered to realize their magnificent potential from such a powerful life changing event.Bonding is enhanced and includes everyone who has contact with the baby, including relatives and neighbors. Breast feeding is facilitated by the baby remaining with the mother. On the other hand, many mothers feel safest laboring at a hospital. It is the safest environment for the mother at risk of medical complications during labor. It is the only option available should a cesarean be necessary. Immediate pediatric attention is 14

available should the newborn need immediate medical care. It has round-the-clock help for the mother and baby. In this study, the 150 respondents are the pregnant and post-partum mothers from Dassun, Solana; Cataggaman Viejo and Annafunan East, Tuguegarao City.

Convenience/opportunity sampling was used to have the 150 respondents and were asked to answer the questionnaires prepared. The data gathered were tallied, analyzed and interpreted. Factors affecting the decision of women in choosing the place of delivery of their children was shown and discussed in Table 3.

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CONCLUSION: Nowadays, there are a lot of things to consider in starting a family and choosing the birthing method is one of them. This is a critical decision that needs to be made by the expected parents. It will directly affect not only the child but also the stability of the family. Many studies will show that most women today would prefer home birth than hospital birth because of financial reasons and some other factors. There are some women that would choose to have home birth because they want to experience the true meaning of giving birth. Issues of risk and vulnerability, such as lack of money, lack of transport, sudden onset of labour, short labour, staff attitudes, lack of privacy, tradition and cultures and the pattern of decision-making power within the household were perceived as key determinants of the place of delivery With the proper information and consideration of the options parents must see to it that whatever birthing method chosen would assure the safe delivery of their child. In this study, 88 out of 150 women (58.67%) chose Home Birth and the 62 remaining chose Hospital Birth(41.33%). The factors that affect whether to choose Home Birth or Hospital Birth are safety, accessibility, socioeconomical status and emotional and social support. For women who chose home birth, they consider home birth as economical, safe, intervention-free, comfortable place for labor and delivery, can choose who can become their child birth attendant and have more access to things. Social and emotional support can also be given by family members.

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On the other hand, mothers choosing Hospital birth believes that they are safe in the Hospital. Standard of care they need are met and medical facilities are readily accessible when emergency cases arises.

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RECOMMENDATION: A research like this not only provides data but also gives information to the readers. For future researchers, larger number of respondents must be considered. Respondents must compose of people from different walks of life and also from different places (urban vs rural) to be able to gather different insights on this matter resulting to a more accurate conclusion. As well as including other factors that might affect the decision-making of the respondents such as: Monthly income of the head of the family Occupation of the Father/Mother/Head of the Family

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REFERENCES: 1. BabyZone Editors; Hospital Birth vs. Home Birth: A Debate on Choices; www.babyzone.com/pregnancy/labor-and-delivery/hospital-birth-home-birthdebate_70709 2. Dasgupta A, Deb S. Intranatal care practices in backward villages of West Bengal. J Obstet Gynecol India 2009; 59:312-6 3. Science-Mom; Home Birth vs. Hospital Birth; www.babiesonline.com/articles/pregnancy/home-birth-vs-hopital-birth.asp 4. Smith M, Askew DA. Choosing childbirth provider location rural womens perspective. Rural and Remote Health 6:510. (online),2006 5. Roach SM, Downes S. caring for Australias most remote communities: obstetric services in the Indian Ocean Territories. Rural and Remote Health 7:699. (Online), 2007 6. Boucher, D.,et.al. Staying Home to Give Birth: Why Women in the United States Choose Home Birth. Journal of Midwifery & Womens Health 1526-9523, 2009 7. Leininger M. Culture care theory, research and practice. Nurs Sci Q 1996;9:71-8 8. Pardeshi, GS et al.; Trends in Choosing Place of Delivery and Assistance during Delivery in Nanded District, Maharashtra, India; J HEALTH POPUL NUTR 2011 Feb; 29(I):71-76 9. BabyCenter Philippines Medical Advisory Board (http://www.babycenter.com.ph/pregnancy/labourandbirth/planningyourbabysbirt h/homebirth/)

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Appendix A Variable Matrix Variable Culture Type of Variable Independent Operational Definition Measure Behavior of Variable through Presence Absence

the beliefs, customs, Gathered practices, and social interview behavior of a particular nation or people a statement, principle, or Gathered doctrine that a person or interview group accepts as true the view that one person, object, or course of action Gathered is more desirable than interview another, or a choice based on such a view the process of having a Gathered baby or young emerge from interview the womb at home

Belief

Independent

through Presence Absence

Preferences

Independent

through Positive Negative

Homebirth

Dependent

through Presence Absence

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Appendix B Literature Matrix Author, Title, References 1.Boucher, D. et. al (2009). Staying Home to Give Birth: Why Women in the United States Choose Home Birth. Journal of Midwifery & Womens Health 2009; 54:119 126. www.jmwh.org Objective The aim of the study was to describe the reasons why women choose home birth. Delineated factors -choice of birth settings -health policy -homebirth -childbirth -home delivery -out-of-hospital birth -out-of-hospital deliveries -qualitative descriptive study Methods -Qualitative descriptive study -A convenience sample of 160 women was selected from 272 respondents who completed an online survey about home birth conducted via a Web site (http://homebirth. study.googlepages.c om). Results The women in the study have provided thoughtful insight into the very personal reasons why they planned to deliver their children at home. Their survey responses illustrate that they do care about safety, that they desire a natural birth experience without medical interventions, and that they wish to feel that they are in control of their birth. Women in the study trusted the inherent abilities of their bodies to give birth without interference, in the environment of their own conception. According to the respondents, there is no place like home for a safe, comfortable, peaceful, relaxing birth.

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2.Roach,S.M., Downes, S. Caring for Australia's most remote communities: obstetric services in the Indian Ocean Territories. Rural and Remote Health 7: 699. (Online), 2007 http://www.rrh.org.au

3.Smith, M., Askew, D.A. choosing childbirth provider locationrural womens perspective. Rural and Remote Health 6:510. (Online), 2006. http://rrh.deakin.edu.au

The aims of the qualitative study were to: Determine perceptions of IOT residents about their experiences of on-island and off-island birthing. Gain an understanding of the social, economic and cultural impacts of the obstetric service on IOT residents. Identify possible areas for improvement in the current service and explore potential solutions. The study aims to investigate the factors that influence rural womens choice of childbirth provider location

-general practitioner -health services accessibility -obstetrics -pregnant women -rural health services -rural population

A study was conducted during 2005 to determine the requirements for providing a safe, cost-effective and socially acceptable obstetrics service, and to identify possible areas for improvement in the current service, and to explore potential solutions. This article presents one aspect of the study, involving qualitative analysis of recorded interviews with 28 of the islands women.

Having choice about where the baby would be born was the most significant category of data analysis. In making choice, a number of variables come into play, including positive and negative social, economic, logistical and cultural factors related to the decision. Women were also strongly influenced by issues of safety, and their response to these issues was largely based on their previous experience and understanding of the IOT obstetric service.

-Childbirth provider location -Maternity choice -Pregnant womens experience

Roma, a provincial center approximately 490 km. west of Brisbane, Queensland, Australia has a population of

The study shows 14 women (70%) delivered locally and six (30%) travelled away, comparable with Queensland perinatal data from 1995 to 2003, the women reported a range of reasons that influence their choice of childbirth 22

-Rural obstetrics services, utilization

approximately 15,000 living in the town for surrounding areas. It has a public hospital with a maternity unit, supported by a pediatrician and flying obstetrician. Exploratory study was done, conducting semistructured interviews with 20 women who lived in Roma(or surrounds), and had delivered a baby between January 2001 and August 2004, or were pregnant when interviewed. Themes were extracted from transcripts of audiotapes and field notes and analyzed using an appropriate framework. A subset of interviews were reviewed by both authors and themes compared.

provider location. All participants stated that concerns about the safety of themselves and more importantly, their baby influenced their choice. The availability of familys support and familiarity with the doctor and maternity service influenced choice, as did financial consideration. All participants agreed that delivering in town was logistically much easier, however, some choose to deliver away. Different women were influenced by a different set of factors; however, safety (actual and perceived) appeared to be the overriding concern of all participants.

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4.Wax, J. et al. Maternal and newborn outcomes in planned home birth vs planned hospital births: a metaanalysis Am J Obstet Gynecol 2010;203:243.e1-8. http://www.scribd.com/doc/3427 2060/Wax-Changed-Version-21

We sought to systematically review the medical literature on the maternal and newborn safety of planned home vs planned hospital birth

neonatal mortality, patient safety, planned home childbirth

The study included English-language peer-reviewed publications from developed Western nations reporting maternal and newborn outcomes by planned delivery location. Outcomes summary odds ratios with 95% condence intervals were calculated.

5.Some,T.,Sombie, I., Meda, N. Womens perceptions of homebirths in two rural medical districts in Burkina Faso: a qualitative study http://www.reproductive-healthjournal.com/content/pdf/17424755-8-3.pdf

The purpose of this study was to describe womens perceptions of homebirths in the medical districts of Ouargaye and Diapaga.

A qualitative approach was used to gather information. This information was collected by using focus group discussions and individual interviews with 30

Planned home births were associated with fewer maternal interventions including epidural analgesia, electronic fetal heart rate monitoring, episiotomy, and operative delivery. These women were less likely to experience lacerations, hemorrhage, and infections. Neonatal outcomes of planned home births revealed less frequent prematurity, low birthweight, and assisted newborn ventilation. Although planned home and hospital births exhibited similar perinatal mortality rates, planned home births were associated with signicantly elevated neonatal mortality rates The findings show that homebirths are frequent because of prohibitive distance to health facilities, fast labour and easy labour, financial constraints, lack of decision making power to reach health facilities. The study echoes the need for policy makers to make health 24

women. All the interviews were tape recorded and managed by using QSR NVIVO 2.0, qualitative data management software. 6. Janssen, P. et al. Outcomes of planned home birth with registered midwife versus planned hospital birth with midwife or physician To compare the outcomes of planned home births attended by midwives with those of planned hospital births attended by midwives or physicians. Home birth Hospital Birth The study included all planned home births attended by registered midwives from Jan. 1, 2000, to Dec. 31, 2004, in British Columbia, Canada (n = 2889), and all planned hospital births meeting the eligibility requirements for home birth that were attended by the same cohort of midwives (n = 4752). We also included a matched sample of physicianattended planned hospital births (n = 5331). The primary outcome measure

facilities easily available to rural inhabitants to forestall maternal and child deaths in the two districts.

The rate of perinatal death per 1000 births was 0.35 (95% confidence interval [CI] 0.00 1.03) in the group of planned home births; the rate in the group of planned hospital births was 0.57 (95% CI 0.001.43) among women attended by a midwife and 0.64 (95% CI 0.001.56) among those attended by a physician. Wo men in the planned home-birth group were significantly less likely than those who planned a midwifeattended hospital birth to have obstetric interventions (e.g., electronic fetal monitoring, relative risk [RR] 0.32, 95% CI 0.290.36; assisted vaginal delivery, RR 0.41, 95% 0.33 0.52) or adverse maternal outcomes 25

was perinatal mortality; secondary outcomes were obstetric interventions and adverse maternal and neonatal outcomes.

(e.g., third- or fourth-degree perineal tear, RR 0.41, 95% CI 0.280.59; postpartum hemorrhage, RR 0.62, 95% CI 0.490.77). The findings were similar in the comparison with physician-assisted hospital births. Newborns in the home-birth group were less likely than those in the midwife-attended hospital-birth group to require resuscitation at birth (RR 0.23, 95% CI 0.140.37) or oxygen therapy beyond 24 hours (RR 0.37, 95% CI 0.240.59). The findings were similar in the comparison with newborns in the physician-assisted hospital births; in addition, newborns in the home-birth group were less likely to have meconium aspiration (RR 0.45, 95% CI 0.210.93) and more likely tobe admitted to hospital or readmitted if born in hospital (RR 1.39, 95% CI 1.091.85) Planned home birth attended by a registered midwife was associated with very low and comparable rates of perinatal death and reduced rates of obstetric 26

interventions and other adverse perinatal outcomes compared with planned hospital birth attended by a midwife or physician.

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In-depth interviews, focus group discussions and participant observation were used to explore determinants of home delivery in southern Tanzania. Quantitative data were collected in a crosssectional survey of 21 600 randomly chosen households.

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Appendix C Synthesis Tally Variable Safety Less medical intervention Basic health services accessibility Socioeconomic status Homebirth Culture Tally 5 3 1 2 6 1

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Appendix D Dear Respondents, We, the Master of Science in Nursing students of University of Saint Louis Tuguegarao, are currently conducting a research entitled . In this connection, may we ask for your help by answering the questionnaire. Rest assured that all information you provide will be taken with strict confidentiality. Thank you very much and God Bless. Very truly yours, The Researchers PERSONAL PROFILE Name: ______________________________________________Age: _____Civil Status: ________ Address: _____________________________________________ Date of Birth: _______________ Religion:_______________________________Occupation:_____________________ ___________ Monthly Income: ______________________ Highest Educational Attainment: (Mother) _______________________________ Highest Educational Attainment: (Father) _______________________________ No. Of Children:_____________________ Nearest official delivery facility: Hospital [ ] Barangay Health Centre[ ] Private Clinic or

[ ] Public Hospital Travel time of place of delivery facility: hour [ ] More than 1 hour Health Care Decision Maker: Father jointly [ ] Mother, Father and relatives [ ] Mother [ ] Father [ ] 1-15 minutes [ ] 31-45 minutes

[ ] City Health Office [ ] 16-30 minutes [ ] 46 minutes - 1

Mother and

Did the doctor, nurse, or other health care worker who provided your prenatal care suggest you where to deliver your baby? Check one answer [ ] [ ] [ ] He or she suggested Ill deliver my baby at home He or she suggested I Ill deliver my baby at hospital He or she didnt suggest where to deliver my baby. 30

Type of delivery

[ ]

Homebirth

[ ]

Hospital/ Lying in Birth

Answer Question A if you undergo HOME BIRTH, and Question B for HOSPITAL/ LYING IN BIRTH. DIRECTION: Please check the box based on your response. QUESTION A 1.Do you think you can receive a better social support during birthing when youre at home? [ ] YES [ ] NO 2.In your culture, do fathers usually attend births? [ ] YES [ ] NO 3.Does your partner want to attend the birth of his child? [ ] YES [ ] NO 4.Are there any beliefs or customs prohibiting physical activity during pregnancy, birth and the postpartum period? [ ] YES [ ] NO 5.Do you plan to observe these? [ ] YES [ ] NO 6.Do you find it more clean in your own home? [ ] YES [ ] NO 7.Does distance between the place of residence and Hospitalhinder you to go to the hospital? [ ] YES [ ] NO 8.Do you think that it is safeand expect better outcomes in home delivery? [ ] YES [ ] NO 9.Did you submit yourself in home birth because its intervention free? [ ] YES [ ] NO 10.Have you had a negative previous hospital experience that is why you didnt undergo Hospital Delivery? [ ] YES [ ] NO 11.Do you find it more comfortable birthing at home than hospital? [ ] YES [ ] NO 12.Is it important for you to have privacy during birthing, and it can be provided at home? [ ] YES [ ] NO 13.Do you think it is better for the baby if it is born at home? [ ] YES [ ] NO 14.Is it important for you to be assisted by your preferred caregiver? [ ] YES [ ] NO 15.Is there anyone in your familyexperienced home birth that is why you go through it? [ ] YES [ ] NO 16.Do you have fear in surrendering to hospital Doctors? [ ] YES [ ] NO 31

17.You have a history of fast labor that is why you prefer giving birth at home? [ ] YES [ ] NO 18.It is unplanned delivery so your only choice is giving birth at home? [ ] YES [ ] NO 19.Do you think it is more economical in birthing at home? [ ] YES [ ] NO 20.Do you consider things you needed are more accessible when birthing at home? [ ] YES [ ] NO

QUESTION B 1.Do you recognized high risk factor in birthing and thats the reason for going through hospital birth? [ ] YES [ ] NO 2. In your culture, do fathers usually attend births? [ ] YES [ ] NO 3.Does your partner want to attend the birth of his child? [ ] YES [ ] NO 4.Are there any beliefs or customs prohibiting physical activity during pregnancy, birth and the postpartum period? [ ] YES [ ] NO 5.Do you plan to observe these? [ ] YES [ ] NO 6.Are you better cared off in the hospital? [ ] YES [ ] NO 7.Do you find it more clean birthing at hospital? [ ] YES [ ] NO 8.Does distance between the place of residence and Hospital didnt hinder you to go to the hospital? [ ] YES [ ] NO 9.Do you think that it is safe and expect better outcomes in hospital delivery? [ ] YES [ ] NO 10.Did you submit yourself for hospital birth even though you are expecting to have a medical intervention? [ ] YES [ ] NO 11.Do you think it is better for the baby if it is birth at hospital? [ ] YES [ ] NO 12.Do you find it more comfortable birthing at hospital than home? [ ] YES [ ] NO 13.Is it important for you to have privacy during birthing and you think it is provided in hospital setting? [ ] YES [ ] NO 32

14.Is it important for you to be assisted by your preferred caregiver? [ ] YES [ ] NO 15.Is there anyone in your family experienced hospital birth that is why you go through it? [ ] YES [ ] NO 16.Dont you have any fear in surrendering to hospital doctors? [ ] YES [ ] NO 17.Do you think hospital birth meets your standard of care you want to receive? [ ] YES [ ] NO 18.Do you consider things you needed are more accessible when birthing at hospital? [ ] YES [ ] NO

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