Outcomes by birth setting and caregiver for low risk women in Indonesia

A systematic literature review

Kai Hodgkin, Grace Joshy, Jenny Browne, Istri Bartini, Terence H. Hull, Kamalini Lokuge

Research output: Contribution to journalReview article

Abstract

Background: Care for women during pregnancy, labour, birth and the postpartum period is essential to reducing maternal and neonatal mortality and morbidity, however the ideal place and organisation of care provision has not been established. The World Health Organization recommends a two-tier maternity care system involving first-level care in community facilities, with backup obstetric hospital care. However, evidence from high-income countries is increasingly showing benefits for low risk women birthing outside of hospital with skilled birth assistance and access to backup care, including lower rates of intervention. Indonesia is a lower middle-income country with a network of village based midwives who attend births at homes, clinics and hospitals, and has reduced mortality rates in recent decades while maintaining largely low rates of intervention. However, the country has not met its neonatal or maternal mortality reduction goals, and it is unclear whether greater improvements could be made if all women birthed in hospital. Body: This paper reviewed the literature on birth outcomes by place of birth and/or caregiver for women considering their risk of complications in Indonesia. A systematic literature search of Pubmed, CINAHL, CENTRAL, Web of Science, Popline, WHOLIS and clinical trials registers in 2016 and updated in 2018 resulted in screening 2211 studies after removing duplicates. Twenty four studies were found to present outcomes by place of birth or caregiver and were included. The studies were varied in their findings with respect of the outcomes for women birthing at home and in hospital, with and without skilled care. The quality of most studies was rated as poor or moderate using the Effective Public Health Practice Project Quality Assessment Tool. Only one study gave an overall assessment of the risk status of the women included, making it impossible to draw conclusions about outcomes for low risk women specifically; other studies adjusted for various individual risk factors. Conclusion: From the studies in this review, it is impossible to assess the outcomes for low risk women birthing with health professionals within and outside of Indonesian hospitals. This finding is supported by reviews from other countries with developing maternity systems. Better evidence and information is needed before determinations can be made about whether attended birth outside of hospitals is a safe option for low risk women outside of high income countries.

Original languageEnglish
Article number67
Pages (from-to)1-12
Number of pages12
JournalReproductive Health
Volume16
Issue number1
DOIs
Publication statusPublished - 28 May 2019

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Indonesia
Caregivers
Parturition
Maternal Mortality
Infant Mortality
Public Health Practice
Women's Rights
Midwifery
PubMed
Postpartum Period
Developing Countries
Obstetrics
Clinical Trials
Organizations
Morbidity
Pregnancy
Mortality
Health

Cite this

Hodgkin, Kai ; Joshy, Grace ; Browne, Jenny ; Bartini, Istri ; Hull, Terence H. ; Lokuge, Kamalini. / Outcomes by birth setting and caregiver for low risk women in Indonesia : A systematic literature review. In: Reproductive Health. 2019 ; Vol. 16, No. 1. pp. 1-12.
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Outcomes by birth setting and caregiver for low risk women in Indonesia : A systematic literature review. / Hodgkin, Kai; Joshy, Grace; Browne, Jenny; Bartini, Istri; Hull, Terence H.; Lokuge, Kamalini.

In: Reproductive Health, Vol. 16, No. 1, 67, 28.05.2019, p. 1-12.

Research output: Contribution to journalReview article

TY - JOUR

T1 - Outcomes by birth setting and caregiver for low risk women in Indonesia

T2 - A systematic literature review

AU - Hodgkin, Kai

AU - Joshy, Grace

AU - Browne, Jenny

AU - Bartini, Istri

AU - Hull, Terence H.

AU - Lokuge, Kamalini

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Y1 - 2019/5/28

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AB - Background: Care for women during pregnancy, labour, birth and the postpartum period is essential to reducing maternal and neonatal mortality and morbidity, however the ideal place and organisation of care provision has not been established. The World Health Organization recommends a two-tier maternity care system involving first-level care in community facilities, with backup obstetric hospital care. However, evidence from high-income countries is increasingly showing benefits for low risk women birthing outside of hospital with skilled birth assistance and access to backup care, including lower rates of intervention. Indonesia is a lower middle-income country with a network of village based midwives who attend births at homes, clinics and hospitals, and has reduced mortality rates in recent decades while maintaining largely low rates of intervention. However, the country has not met its neonatal or maternal mortality reduction goals, and it is unclear whether greater improvements could be made if all women birthed in hospital. Body: This paper reviewed the literature on birth outcomes by place of birth and/or caregiver for women considering their risk of complications in Indonesia. A systematic literature search of Pubmed, CINAHL, CENTRAL, Web of Science, Popline, WHOLIS and clinical trials registers in 2016 and updated in 2018 resulted in screening 2211 studies after removing duplicates. Twenty four studies were found to present outcomes by place of birth or caregiver and were included. The studies were varied in their findings with respect of the outcomes for women birthing at home and in hospital, with and without skilled care. The quality of most studies was rated as poor or moderate using the Effective Public Health Practice Project Quality Assessment Tool. Only one study gave an overall assessment of the risk status of the women included, making it impossible to draw conclusions about outcomes for low risk women specifically; other studies adjusted for various individual risk factors. Conclusion: From the studies in this review, it is impossible to assess the outcomes for low risk women birthing with health professionals within and outside of Indonesian hospitals. This finding is supported by reviews from other countries with developing maternity systems. Better evidence and information is needed before determinations can be made about whether attended birth outside of hospitals is a safe option for low risk women outside of high income countries.

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KW - Delivery

KW - Development

KW - Homebirth

KW - Indonesia

KW - Midwifery

KW - Midwives

KW - Obstetric care

KW - Parturition

KW - Skilled birth attendant

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