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Association between birth attendant type and delivery site and perinatal outcomes
Author(s) -
Manasyan Albert,
Chomba Elwyn,
Moore Janet,
Wallace Dennis,
McClure Elizabeth M.,
KosoThomas Marion,
Carlo Waldemar A.
Publication year - 2019
Publication title -
international journal of gynecology and obstetrics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.895
H-Index - 97
eISSN - 1879-3479
pISSN - 0020-7292
DOI - 10.1002/ijgo.12786
Subject(s) - medicine , odds ratio , referral , obstetrics , confidence interval , population , standardized mortality ratio , infant mortality , observational study , birth attendant , neonatal mortality , perinatal mortality , pregnancy , pediatrics , fetus , nursing , environmental health , maternal health , health services , genetics , biology
Objective To test the hypothesis that modified perinatal mortality, early neonatal mortality, and other measures of perinatal mortality are lower with facility births than with home births among deliveries conducted by traditional birth attendants ( TBA s) or nurse‐midwives. Method This population‐based observational study used data collected prospectively for home and facility deliveries conducted by TBA s and nurse‐midwives in 13 rural communities in Zambia between September 1, 2009, and December 31, 2015. Results We enrolled 48 956 pregnant women. In adjusted analysis, modified perinatal mortality (adjusted odds ratio [ aOR ] 0.63, 95% confidence interval [ CI ] 0.45–0.88), early neonatal mortality (0.48, 0.33–0.69), and fresh stillbirth/day‐1 neonatal mortality (0.55, 0.38–0.80) were lower among home deliveries than among facility deliveries conducted by TBA s, but did not differ among deliveries conducted by nurse‐midwives. Rates of fresh stillbirth did not differ between home and facility delivery by either TBA s ( aOR 1.03, 95% CI 0.64–1.66) or nurse‐midwives (1.19, 0.67–2.10). Conclusion Our findings show significant reductions in modified perinatal mortality, early neonatal mortality, and fresh stillbirth/day‐1 neonatal mortality among home deliveries done by TBA s. This may be explained by robust community structures built by our program and referral bias of complicated cases.