DÜNYADA PLANLI EV DOĞUMLARINA GÜNCEL BAKIŞ; RİSKLER VE FAYDALARI

Year 2019, Volume: 50 Issue: 2, 82 - 90, 15.06.2019

Doç. Dr. Pınar Kumru , Prof. Dr. Ahmet Topuzoğlu

https://doi.org/10.16948/zktipb.531769

Abstract

DÜNYADA PLANLI EV DOĞUMLARINA GÜNCEL
BAKIŞ; RİSKLER VE FAYDALARI

ÖZET:

Gelişmiş ülkelerde planlı
evde doğum oranı %0,1-%20 arasında değişmektedir. Son 20 yıldır özellikle
gelişmiş ülkelerde evde doğum planlayan kadın sayısında artış dikkat
çekicidir.  

Planlı ev doğumlarında
çoğu literatürde birbiri ile uyumlu şekilde maternal sonuçları olumlu olarak
bildirilmişse de yenidoğan sonuçları açısından daha değişkendir.

Daha önceki
araştırmalarda, düşük riskli kadında planlı ev doğumlarında, oksitosin
indüksiyonu, sezaryen/operatif doğum, doğum sonrası kanama, perineal
laserasyon, farmakolajik analjezik ihtiyacı ve epizyotomi gibi müdahale ve
maternal morbiditeler azalmış olarak bildirilmiştir. 

Düşük riskli kadında
intrapartum fetal ölümler, yenidoğan ölümleri, düşük Apgar skorları ve
yenidoğan yoğun bakım ünitesine kabul açısından hastane ve ev doğumları
arasında fark bulunmadığını bildiren araştırmalar yanında artmış olumsuz
yenidoğan sonuçları gösteren araştırmalarda mevcuttur.

Planlı ev doğumları
özellikle nulliparlar gebeler için küçük de olsa artmış yenidoğan riskleri ile
ilişkili bulunmuşken multipar gebeler için daha güvenli olduğu bildirilmiştir.
Fakat makat prezentasyon, çoğul gebelik, ve geçirilmiş sezaryen öyküsü olan
kadınlarda evde doğum önerilmemektedir.

Kadınların ev
doğumlarında çevrelerini daha iyi kontrol edebildikleri, kendi şartlarını
belirleyebildikleri, istemedikleri müdahalelerden kaçınabilecekleri ve doğum
sırasında karar almada etkin rol alabildikleri için memnuniyetlerinin arttığı  bildirilmiştir.   

Evde doğumda bildirilen
diğer avantaj ise maliyet etkinliğidir.

Evde doğum konusunda,
radomize kontrollü çalışmalar yapmak mümkün değildir ayrıca araştırma
tasarımları ile ilgili bir çok zorluk vardır.

Planlı ev doğumlarının sonuçlarını gebelik sırasında
alınan annelik bakımı, gebelik ve doğum sırasında destek veren obstetrisyen ve
ebelerin eğitim düzeyi, hastaneye uzaklık ve transfer koşulları gibi bir çok
faktör etkilemektedir.  

Uluslararası kabul görmüş
standartlara dayanan uygulama ve kılavuzların kullanımı evde doğum güvenliği
için önemlidir.

Evde doğum, klavuzlar rehberliğinde,
eğitimli ebe/obstetrisyen eşliğinde veya
sağlık sistemine entegre transfer sistemlerinin varlığında, düşük riskli
kadınlar için özellikle yenidoğan sonuçları açısından risklerin çok az veya
hastane doğumlarına benzer olduğu tespit edilmiştir. 

Bu derleme, planlı ev
doğumlarını maternal ve neonatal sonuçlar ile olan ilişkisinini güncel
araştırmalar ışığında  gözden geçirecek
ve planlı ev doğumlarının riskleri ve faydaları tartışacaktır.

Anahtar Kelimeler: Ev doğumu, hastane doğumu, Düşük riskli gebelik,
riskler, faydalar, maternal sonuçlar, yenidoğan sonuçları

Keywords

Ev doğumu, hastane doğumu, Düşük riskli gebelik, riskler, faydalar, maternal sonuçlar

A CURRENT OVERVIEW OF PLANNED HOME DELIVERIES IN THE WORLD; RISKS AND BENEFITS

Abstract

A CURRENT OVERVIEW OF PLANNED HOME DELIVERIES IN THE
WORLD; RISKS AND BENEFITS

SUMMARY:

In developed countries, the planned
home delivery rate varies between 0.1% and 20%. In
the last 20 years, especially in developed countries, the number of women
planning birth at home increased noteworthy.

For planned home births, most
maternal outcomes were reported positive, and are compatible with each other
according to the results in the previous literature. However, the results for
the neonatal outcomes are more variable.

Planned home births in low-risk women
results with lower levels of oxytocin induction, cesarean/operative delivery,
postpartum hemorrhage, perineal laceration, need
for pharmacologic analgesic and episiotomy intervention and maternal morbidity, according to the previous reports.

In addition to the studies
indicating that there are no differences for low-risk women between hospital
and home births; in terms of intrapartum fetal deaths, neonatal deaths, low
Apgar scores, and admission to the neonatal intensive care unit rates, other studies report increased negative neonatal outcomes.

Planned home births are reported to
be safer for multiparous pregnancies, especially when they are compared with
nulliparous women who have small but significantly increased neonatal risks.
However, home delivery is not recommended for women with breech presentation,
multiple pregnancies and previous cesarean section.

It has been reported that women are
better able to control their environment in home births, determine their own
conditions, avoid undesired interventions, and increase their satisfaction
because they can play an active role in decision-making at birth.

Another advantage for home deliveries
is cost effectiveness.

On the subject of birth at home,
there is an obstacle on research designs because it is not feasible to conduct
randomized controlled studies.

Planned home births were effected by
maternal care during pregnancy, the level of education of obstetricians and
midwives who support during pregnancy and delivery, and the distance to
hospital and transfer conditions for the mothers.

The practices and guidelines based on
the internationally accepted standards are important for the home birth safety.

It was found that in the presence of
trained midwives / obstetrician guided guidance and integrated transfer
systems, the risks of home birth for low-risk women were very few or similar to
hospital deliveries, especially in the terms of newborn results.

This review will evaluate the
relationship between planned home births and maternal and neonatal outcomes
with regard to current studies and discuss the risks and benefits of planned
home births.

Keywords: Home birth, hospital
birth, low risk pregnancy,
without risk, benefit maternal outcomes, neonatal outcomes

Keywords

Home birth, hospital birth, low risk pregnancy, without risk, benefit maternal outcomes

References

• National Institute for Health and Care Excellence. Intrapartum care for healthy women and babies. Clinical Guideline 190. London: NICE; 2014. Retrieved October 24, 2016.
• Chen CY, Wang KG (2006) Are routine interventions necessary in normal birth? Taiwanese J Obstet Gynecol 45 (4): 302-306.
• Hodnett ED, Downe S, Walsh D. Alternative versus conventional institutional settings for birth. Cochrane Database Syst Rev. 2012 Aug 15;(8):CD000012.
• Cochrane, AL. 1931-1971: a critical review with particular reference to the medical profession. In: Teeling-Smith, G.; Wells, N., editors. Medicines For The Year 2000. Office of Health Economics; London: 1979. p. 2-12. Cochrane 1979.
• WHO 1996. World Health Organization. Maternal and Newborn Health/Safe Motherhood Unit. Care in Normal Birth: a Practical Guide (WHO/FRH/MSM/96.24). WHO; Geneva: 1996.
• EURO-PERISTAT 2008 . [accessed 2012] EURO-PERISTAT Project, with SCPE, EUROCAT, EURONEOSTAT. European Perinatal Health Report. 2008. http://www.europeristat.com/our-publications/european-perinatal-health-report.html
• Souza JP, Betran AP, Dumont A, De Mucio B, GibbsPickens CM, Deneux-tharaux C, et al. A global reference for caesarean sectionrates (C-Model): a multicountrycross-sectionalstudy. BJOG, 2016;123(3):427-36.
• Buckley SJ. Executive Summary of Hormonal Physiology of Childbearing: Evidence and Implications for Women, Babies, and Maternity Care. J Perinat Educ. 2015;24(3):145-53. doi: 10.1891/1058-1243.24.3.145.
• Odent M. Childbirth in the Age of Plastics. Pinter & Martin. London 2011. ISBN: 9781780663883.
• Paolisso M, Leslie J. Meeting the changing health needs of women in developing countries. Soc Sci Med 1995; 40:55-65.
• Mbizvo MT, Fawcus S, Lindmark G, Nyström L, and the Maternal Mortality Study Group. Operational factors of maternal mortality in Zimbabwe. Health Pol and Plann 1993; 8(4):369-378.
• Smith DG. Safe Motherhood: listening to women. Tropical Doctor 1993; 23:1-2.
• Office for National Statistics. Births in England and Wales by Characteristics of Birth 2, 2012. Available from: http://www.ons.gov.uk/ ons/rel/vsob1/characteristics-of-birth-2-england-and-wales/2012/ sb-characteristics-of-birth-2.html. Accessed February 13, 2015.
• MacDorman MF, Mathews TJ, Declercq E. Trends in Out-of-Hospital Births in the United States, 1990–2012. NCHS Data Brief. 2014; No 144.
• New Zealand Ministry of Health – Maternity Tables 2011. Available from: http://www.health.govt.nz/publication/maternity-tables-2011#home. Accessed February 13, 2015.
• de Jonge A, Geerts CC, van der Goes BY, Mol BW, Buitendijk SE, Nijhuis JG. Perinatal mortality and morbidity up to 28 days after birth among 743 070 low-risk planned homeand hospital births: a cohort study based on three merged national perinatal databases. BJOG. 2015 Apr;122(5):720-8.
• Akadlı Ergöçmen B, Çavlin A, Abbasoğlu Özgören A. [Reproductive health]. Türkiye Nüfus ve Sağlık Araştırması 2013. 1. Baskı. Ankara: Hacettepe Üniversitesi Nüfus Etütleri Enstitüsü; 2014. p.141-56.
• Koç İ, Yüksel Kaplanoğlu İ, Eryurt MA. [Infant and child mortality]. Türkiye Nüfus ve Sağlık Araştırması 2013. 1. Baskı. Ankara: Hacettepe Üniversitesi Nüfus Etütleri Enstitüsü; 2014. p.129-40.
• Mansuroğlu YE, Dilbaz B. Planlı Evde Doğum Guvenli midir? Kadın Doğum Dernekleri Ne Diyor? Turkiye Klinikleri J Gynecol Obst 2017;27(4):184-92
• Planned Home Birth. Committee on Obstetric Practice Number 697, April 2017 (Replaces Committee Opinion Number 669, August 2016) (Reaffirmed 2018)
• FIGO Committee for the Ethical Aspects of Human Reproduction and Women’s Health. Planned home birth. FIGO Committee Report. February 2013;120(2):204-5.
• Royal College of Obstetricians and Gynaecologists/ Royal College of Midwives. Home births. RCOG/RCM Joint Statement. No 2. London: RCOG; April 2007. p.1-6.
• Society of Obstetricians and Gynaecologists of Canada. Midwifery. SOGC Policy Statement No. 126. J Obstet Gynaecol Can March 2003;25(3):239.
• American College of Nurse-Midwives. Position Statement – Home Birth. Available from: www.midwife.org. Accessed February 13, 2015.
• Midwives Alliance of North America. Home birth statement. 2012 Available from:http://mana.org/pdfs/MANAPositionStatements.pdf. Accessed December 17, 2014.
• American Academy of Pediatrics. Policy statement: planned home birth. Pediatrics. 2013;131:1016–1020.
• Grünebaum A, McCullough LB, Brent RL, Arabin B, Levene MI, Chervenak FA. Perinatal risks of planned home births in the United States. Am J Obstet Gynecol. 2015 Mar;212(3):350.e1-6.
• Hamilton BE, Martin JA, Ventura SJ. Births: preliminary data for 2012. Natl Vital Stat Rep. 2013;62:1-20.
• MacDorman MF, Declercq E, Menacker F. Trends and characteristics of home births in the United States by race and ethnicity, 1990-2006. Birth. 2011;38:17-23.
• Zafman KB, Stone JL, Factor SH. Trends in characteristics of women choosing contraindicated home births. J Perinat Med. 2018 Aug 28;46(6):573-577.
• Hildingsson I, Lindgren H, Haglund B, Radestad I. Characteristics of women giving birth at home in Sweden: a national register study. Am J Obstet Gynecol. 2006;195(5):1366–1372.
• Dowswell T, Thornton JG, Hewison J, Lilford RJL. Should there be a trial of home versus hospital delivery in the United Kingdom? Measuring outcomes other than safety is feasible. BMJ. 1996;312:753–757.
• Hendrix M, Van Horck M, Moreta D, Nieman F, Nieuwenhuijze M, Severens J, Nijhuis J. Why women do not accept randomisation for place of birth: feasibility of a RCT in The Netherlands. BJOG: An International Journal of Obstetrics and Gynaecology. 2009; 116(4):537–42.
• van der Kooy J1, Birnie E,3, Denktas S, Steegers EAP, Bonsel GJ,. Planned home compared with planned hospital births: mode of delivery and Perinatal mortality rates, an observational study.BMC Pregnancy Childbirth. 2017 Jun 8;17(1):177.
• Kataoka Y, Eto H, Iida M. Outcomes of independent midwifery attended births in birth centres and home births: a retrospective cohort study in Japan. Midwifery. 2013;29:965–972.
• Blix E, Huitfeldt AS, Øian P, Straum B, Kumle M. Outcomes of planned home births and planned hospital births in low-risk women in Norway between 1990 and 2007: a retrospective cohort study. Sex Reprod Healthcare. 2012;3:147–153.
• Birthplace in England Collaborative Group, Brocklehurst P, Hardy P, Hollowell J, Linsell L, Macfarlane A, McCourt C, Marlow N, Miller A, Newburn M, Petrou S, Puddicombe D, Redshaw M, Rowe R, Sandall J, Silverton L, Stewart M. Perinatal and maternal outcomes by planned place of birth for healthy women with low risk pregnancies: the Birthplace in England national prospective cohort study. BMJ. 2011 Nov 23;343:d7400. doi: 10.1136/bmj.d7400.
• de Jonge A, Mesman AJ, Mannien J, Zwart JJ, van Dillen J, van Roosmalen J. Severe adverse maternal outcomes among low risk women with planned home versus hospital births in the Netherlands: nationwide cohort study. BMJ. 2013;346.
• Davis D, Baddock S, Pairman S, Hunter M, Benn C, Wilson D, Dixon L, Herbison P. Planned place of birth in New Zealand: does it affect mode of birth and intervention rates among low risk women? Birth. 2011;38(2):111–119.
• Johnson KC, Daviss B. Outcomes of planned home births with certified professional midwives: large prospective study in North America. BMJ. 2005;330:1416–1419.
• Cheyney M, Bovbjerg M, Everson C, Gordon W, Hannibal D, Vedam S. Outcomes of care for 16,924 planned home births in the United States: the Midwives Alliance of North America statistics project, 2004 to 2009. J Midwifery Womens Health. 2014;59(1):17–27.
• Collaborative survey of perinatal loss in planned and unplanned home births. Northern Region Perinatal Mortality Survey Coordinating Group. BMJ. 1996;313(7068):1306–1309.
• Rossi AC, Prefumo F. Planned home versus planned hospital births in women at low-risk pregnancy: A systematic review with meta-analysis. Eur J Obstet Gynecol Reprod Biol. 2018 Mar;222:102-108.
• Hutton EK, Cappelletti A, Reitsma AH, Simioni J, Horne J, McGregor C, Ahmed RJ. Outcomes associated with planned place of birth among women with low-risk pregnancies. CMAJ. 2016 Mar 15;188(5):E80-90.
• Janssen PA, Saxel L, Page LA, Klein MC, Liston RM, Lee SK. Outcomes of planned home birth with registered midwife versus planned hospital birth with midwife or physician. CMAJ. 2009;181(6–7):377–383.
• Grünebaum A, McCullough LB, Sapra KJ, et al. Apgar score of zero at five minutes and neonatal seizures or serious neurologic dysfunction in relation to birth setting. Am J Obstet Gynecol. 2013;209:323:e1–e6.
• Cheng YW, Snowden JM, King TL, Caughey AB. Selected perinatal outcomes associated with planned home births in the United States. Am J Obstet Gynecol. 2013;209(4):325. e1–8.
• Grünebaum A, McCullough LB, Sapra KJ, Brent RL, Levene MI, Arabin B, Chervenak FA. Early and total neonatal mortality in relation to birth setting in the United States, 2006-2009. Am J Obstet Gynecol. 2014 Oct;211(4):390.e1-7.
• Zollinger TW, Przbylski MJ, Gamache RE. Reliability of Indiana birth certificate data compared to medical records. Ann Epidemiol. 2006;16(1):1–10.
• Grünebaum A, McCullough LB, Sapra KJ, Arabin B, Chervenak FA. Planned home births: the need for additional contraindications. Am J Obstet Gynecol. 2017 Apr;216(4):401.e1-401.e8. doi: 10.1016/j.ajog.2017.01.012. Epub 2017 Jan 30.
• Cox KJ, Schlegel R, Payne P, Teaf D, Albers L. Outcomes of planned home births attended by certified nurse-midwives in Southeastern Pennsylvania, 1983–2008. J Midwifery Womens Health. 2013;58(2):145–149.
• Kennare RM, Keirse MR, Tucier GR, Chan AC. Planned home and hospital births in South Australia 1991–2006: differences in outcomes. MJA. 2010;192:76–80.
• Cheyney M, Everson C, Burcher P. Homebirth transfers in the United States: narratives of risk, fear, and mutual accommodation. Qual Health Res. 2014;24(4):443–456.
• Homer CS, Thornton C, Scarf VL, Ellwood DA, Oats JJ, Foureur MJ, Sibbritt D, McLachlan HL, Forster DA, Dahlen HG. Birthplace in New South Wales, Australia: an analysis of perinatal outcomes using routinely collected data. BMC Pregnancy Childbirth. 2014;14:206.
• Catling-Paul C, Coddington RL, Foureur MJ, Homer CS. Publicly funded homebirth in Australia: a review of maternal and neonatal outcomes over 6 years. MJA. 2013;198(1):616–620
• Hutton E, Reitsma A, Kaufman K. Outcomes associated with planned home and planned hospital births in low-risk women attended by mid¬wives in Ontario, Canada, 2003–2006: a retrospective cohort study. Birth. 2009;36(3):180–189.
• de Jonge A, van der Goes BY, Ravelli AC, Amelink-Verburg MP, Mol BW, Nijhuis JG, Bennebroek Gravenhorst J, Buitendijk SE.. Perinatal mortality and morbidity in a nationwide cohort of 529,688 low risk planned home and hospital births. BJOG. 2009;116:1177–1184.
• Wax JR, Lee Lucas F, Lamont M, Pinette MG, Cartin A, Blackstone J. Maternal and newborn outcomes in planned home birth vs planned hospital births: a metaanalysis. Am J Obstet Gynecol. 2010;203:243e1–243e8.
• Davies-Tuck ML, Wallace EM, Davey MA, Veitch V, Oats J. Planned private homebirth in Victoria 2000-2015: a retrospective cohort study of Victorian perinatal data. BMC Pregnancy Childbirth. 2018 Sep 4;18(1):357. doi: 10.1186/s12884-018-1996-6.
• Davies-Tuck ML, Wallace EM, Davey MA, Veitch V, Oats J. Planned private homebirth in Victoria 2000-2015: a retrospective cohort study of Victorian perinatal data. BMC Pregnancy Childbirth. 2018 Sep 4;18(1):357. doi: 10.1186/s12884-018-1996-6.
• American College of Obstetricians and Gynecologists. Safe prevention of the primary cesarean delivery. Obstetric Care Consensus No 1. Obstet Gynecol. 2014;123:693–711.
• Bernhard C, Zielinski R, Ackerson K, English J. Home birth after hospital birth: women’s choices and reflections. J Midwifery Womens Health. 2014;59(2) :160–166.
• Catling C, Dahlen H, Homer CS. The influences on women who choose publicly-funded home birth in Australia. Midwifery. 2014;30 (7):892–898.
• Jouhki M. Choosing homebirth: the women’s perspective. Women Birth. 2012;25(4):e56–e61.
• Lindgren H, Erlandsson K. Women’s experiences of empowerment in a planned home birth: a Swedish population-based study. Birth. 2010;37(4):309–317.
• Farrish J, Von Robertson R. A qualitative examination of factors that influence birthing options for African American women. Critical Sociology. 2012;40(2):271–283.
• Merg AL, Carmoney P. Phenomenological experiences: homebirth after hospital birth. Int J Childbirth Ed. 2012;27:70.
• Coxon K, Chisholm A, Malouf R, Rowe R, Hollowell J. What influences birth place preferences, choices and decision-making amongst healthy women with straightforward pregnancies in the UK? A qualitative evidence synthesis using a 'best fit' framework approach. BMC Pregnancy Childbirth. 2017 Mar 31;17(1):103.
• Hinton L, Dumelow C, Rowe R, Hollowell J. Birthplace choices: what are the information needs of women when choosing where to give birth in England? A qualitative study using online and face to face focus groups. BMC Pregnancy Childbirth. 2018 Jan 8;18(1):12.
• Hildingsson I, Radestad, Lindgren H. Birth preferences that deviate from the norm in Sweden: planned home birth versus planned cesarean section. Birth. 2010;288–295.
• Zielinski R, Ackerson K, Kane Low L. Planned home birth: benefits, risks, and opportunities. Int J Womens Health. 2015 Apr 8;7:361-77.
• Jouhki M. Choosing homebirth: the women’s perspective. Women Birth. 2012;25(4):56–61.
• Jamshidi Manesh M, Kalati M, Hosseini F. Snoezelen Room and Childbirth Outcome: A Randomized Clinical Trial. Iran Red Crescent Med J. 2015 May; 17(5): e18373.
• Nieuwenhuijze M, Low LK. Facilitating women's choice in maternity care. J Clin Ethics. 2013 Fall;24(3):276-82.
• Dietz HP. Women and babies need protection from the dangers of normal birth ideology: FOR: The recent maternity review risks making the situation even worse. BJOG. 2017 Aug;124(9):1384.
• Page L. Women and babies need protection from the dangers of normal birth ideology: AGAINST: Support for normal birth is crucial to safe high-quality maternity care. BJOG. 2017 Aug;124(9):1385.
• McCullough LB, Grünebaum A, Arabin B, Brent RL, Levene MI, Chervenak FA. Ethics and professional responsibility: Essential dimensions of planned home birth.Semin Perinatol. 2016 Jun;40(4):222-6.
• Chervenak FA, McCullough LB, Grünebaum A, Arabin B, Levene MI, Brent RL. Planned home birth in the United States and professionalism: a critical assessment. J Clin Ethics. 2013;24(3):184–191.
• Oxford Pro Bono Publico. The legal regulation of home birth in the Domestic jurisdictions of the council of Europe. Research prepared for the League of human rights, the Czech Republic [Internet]. 2015 [cited 2002 Jul 9] Available from: http://ohrh.law.ox.ac.uk/wordpress/wp-content/ uploads/2015/03/here.pdf.
• NICE. Intrapartum care for healthy women and babies. Clinical guideline [Internet]. London [cited 2017 Sept 9] Available from: https://www. nice.org.uk/guidance/cg190.
• American college of Nurse-Midwives. Home Birth Transfer Guidelines [Internet].Silver Spring [cited 2017 Oct 29] Available from: http://www. midwife.org.
• Care in normal birth: a practical guide. Technical Working Group, World Health Organization. Birth. 1997;24(2):121-3.
• Hollowell J, Rowe R, Townend J, Knight M, Li Y, Linsell L, Redshaw M, Brocklehurst P, Macfarlane A, Marlow N, McCourt C, Newburn M, Sandall J, Silverton LThe Birthplace in England national prospective cohort study: further analyses to enhance policy and service delivery decision-making for planned place of birth. Southampton (UK): NIHR Journals Library; 2015 Aug. Health Services and Delivery Research.
• McCourt C, Rayment J, Rance S, Sandall J. Organizational strategies and midwives’ readiness to provide care for out of hospital births: an analysis from the Birthplace organizational case studies. Midwifery. 2012;28:636–645.
• Thompson JB, Fullerton JT, Sawyer AJ; International Confederation of Midwives. The International Confederation of Midwives: Global Standards for Midwifery Education (2010) with companion guidelines. Midwifery. 2011 Aug;27(4):409-16.
• Cook D, Avery M, Frisvold M. Formulating evidence-based guidelines for certified nurse-midwives and certified midwives attending home births. J Midwifery Womens Health. 2014;59:153–159.
• Obstetric Working Group. Obstetric Manual: Final Report of the Obstetric Working Group of the National Health Insurance Board of the Netherlands. The List of Obstetric Indications. Amstelveen, Netherlands: Royal Dutch Association of Midwives; 2010.
• Schroeder E, Petrou S, Patel N, Hollowell J, Puddicombe D, Redshaw M, Brocklehurst P; Birthplace in England Collaborative Group. Cost effectiveness of alternative planned places of birth in women at low risk of complications: evidence from the Birthplace in England national prospective cohort study. BMJ. 2012;344:e2292
• https://khgmsaglikhizmetleridb.saglik.gov.tr/TR,42834/anne-dostu-hastane-kriterleri.html.