Influence of alternative birth methods on traditional birth management.
BACKGROUND
Because of popular demand for more natural childbirth, a new concept was introduced in 1991 in our clinic. It consisted of careful monitoring and birth management, restrictive use of invasive methods, and free choice of different birth methods including waterbirths and other alternative birth methods. Our aim was to determine the influence of our new birth concept on the way women give birth and on the birth management in our clinic.


METHODS
In a total of 9,418 births between 1991 and 1997 [new birth concept KSF (KSF = Kantonsspital Frauenfeld)], the changing pattern of birth methods and birth management in our clinic under the influence of the new birth concept were analysed. The results were compared to a historical group in our clinic, a total of 5,602 births from 1986 to 1990, and to data from a contemporary group from Swiss clinics, a total of 344,328 births from 1986 to 1997.


RESULTS
Our study shows that alternative birth methods are very popular. The waterbirth rates have risen steadily and stabilized at around 40-50% of the spontaneous births. The Maia-birthing stool births rates reached a peak of popularity in 1993 (23%) 5 years after their introduction, dropping again to 10% of the spontaneous births. The bedbirth rates have stabilized at around 40% of the spontaneous births. Other birth methods such as standing, supported by a rope, on the mat or on all fours are much less popular. The impact of our new birth concept on different aspects of birth management differs greatly from one to another. The episiotomy rate has dropped from a previous rate higher than 80% to a rate lower than 15%. The caesarean section rate in our clinic (around 10%) has remained substantially below the Swiss average (around 15%). The rate of the spinal and epidural analgesia was maintained at a constant level, around 13%, while the Swiss average rates doubled and reached 23% in 1997. The induction and amniotomy rates as well as the use of oxytocin were not influenced by the new birth concept and are comparable to the Swiss average.


CONCLUSIONS
Alternative birth methods and in particular waterbirths are very sought after. This popular pressure insisting upon less invasive, more natural birth management can be well integrated into the security-oriented way of thinking of classical medicine. In our clinic the general trend towards more invasive measures in birth management could be countered by the introduction of a new birth concept with alternative birth methods.
Eberhard
J
J
Clinic for Obstetrics and Gynecology, Cantonal Hospital, Frauenfeld, Switzerland.
Geissbühler
V
V
D015360:Analgesia, Epidural / Q000706:statistics & numerical data; D001723:Birth Rate; D002585:Cesarean Section / Q000706:statistics & numerical data; D003696:Delivery Rooms; D004841:Episiotomy / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007751:Labor, Induced / Q000706:statistics & numerical data; D009321:Natural Childbirth / Q000379:methods* / Q000706:statistics & numerical data; D011247:Pregnancy; D011446:Prospective Studies; D013557:Switzerland / Q000453:epidemiology