title: Home-like versus conventional institutional settings for birth.
abstract: BACKGROUND
  Many home-like birth centres have been established near conventional labour wards for the care of pregnant women who prefer and require little or no medical intervention during labour and birth.
  
  
  OBJECTIVE
  The objective of this review was to assess the effects of care in a home-like birth environment compared to care in a conventional labour ward, on labour and birth outcomes.
  
  
  METHODS
  The Cochrane Pregnancy and Childbirth Group trials register was searched. Date of last search: July 2001.
  
  
  METHODS
  Randomised and quasi-randomised trials comparing a home-like institutional birth environment to conventional hospital care for pregnant women at low risk of obstetric complications.
  
  
  METHODS
  Trial quality was assessed.
  
  
  RESULTS
  Six trials involving almost 9000 women were included. Substantial numbers of women allocated to home-like settings were transferred to standard care before or during labour. Allocation to a home-like setting was associated with lower rates of intrapartum analgesia/anaesthesia (odds ratio 0.82, 95% confidence interval 0.72 to 0.93), augmented labour (odds ratio 0.72, 95% confidence interval 0.64, 0.81), and operative delivery (odds ratio 0.85, 95% confidence interval 0.70, 0.96), as well as greater satisfaction with care. There was a non-statistically significant trend towards higher perinatal mortality in the home-like setting (odds ratio 1.49, 95% confidence interval 0.79 to 2.78).
  
  
  CONCLUSIONS
  There appear to be some benefits from home-like settings for childbirth, although increased support from caregivers may be more important. Caregivers and clients in home-like settings need to watch for signs of complications.
authors.affiliation: Maternal-Child Nursing Research, University of Toronto, 790 Bay Street, Suite 950, Toronto, Ontario, Canada, M5G 1N8. ellen.hodnett@utoronto.ca
authors.forename: E D
authors.initials: ED
authors.lastname: Hodnett
mesh_terms: D016550:Birthing Centers; D003696:Delivery Rooms; D005260:Female; D006801:Humans; D011247:Pregnancy; D016032:Randomized Controlled Trials as Topic