From the EvaluaAES group we are very happy with the figure keynote speaker which was introduced a couple of editions ago in the Workshop. At the XIII Workshop that we held in Seville we were lucky to have Lucía Alcaraz Vidal with us (Alemanes Trias Hospital) to tell us about his enriching experience in the much-needed hinge of research and health care work. If Lucía’s entry seduces you, let them know that we have just launched the summary call of the XIV EvaluaAES Workshop to be held on May 9 of next year at the Marqués de Valdecilla University Hospital of Cantabria with the collaboration of the Valdecilla Research Institute (IDIVAL). In this way, not only will they have the opportunity to present their work and have it discussed by a high-level commentator, but they will also be able to enjoy once again the figure of keynote speaker that He looked so well compatible last year and he tells you about it in the following lines.
By Lucía Alcaraz Vidal
Research on different care models for giving birth is poor in our country. The personal experience of my pregnancies and births, as well as the associative work with the home birth midwives of Catalonia (ALPACC in its Catalan acronym) made me consider the need to investigate and make public the data that the ALPACC midwives collect on a regular basis. . structured since 2015. Home birth in Spain represents 0.32% of all births. Thanks to the data collected by ALPACC, we know that a third of home births in Spain are assisted in Catalonia.
My care and entrepreneurship work as a home birth midwife, along with the management and leadership of Casa Laietania – Centro de Nacimientos del Alemanes Trias HospitalThey form the basis of my research work. The birth center project arose in 2019, to respond to one of the strategic lines of the Health Plan of Catalonia 2016-2020 and at the initiative of the Directorate of Obstetrics of the Hospital German Trias.
When I considered doing my doctoral thesis in this field, I little imagined what it would entail in terms of time and effort and that along the way I would have the option of implementing a birth center in a highly complex public hospital. Both projects, doctoral thesis and birth center, have occupied body, mind and soul in the last six years.
Along the way I have learned about research, but especially about how research impacts care and vice versa. Investigating home birth led us to improve data collection, to highlight the lack of traceability of the data of women who were transferred to the hospital, and to make visible how the transfer impacts the women’s experience. . . Hence, the work being done on home birth in Catalonia for real and correct coordination with hospitals and emergency services in case of transfer. Regarding research on the birth center, the results found have impacted care in terms of improving obstetric indicators such as episiotomies, as well as the inclusion of water birth and the use of nitrous oxide (as analgesic measure) throughout the service, not only in the birth center. Furthermore, as a result of this work, work is being done to improve two of the most important indicators in childbirth care, such as: postpartum hemorrhage and intrapartum fetal hypoxia. The cost-effectiveness analysis of these care models still needs to be investigated in our context.
Next, I tell you about the work of my doctoral thesis that I presented at the XIII EvaluAES Workshop. Motherhood and childbirth are crucial times in a woman’s life, and the care she receives during this period can have a significant impact on outcomes for both mother and newborn. In this context, various models of maternity care stand out, defined by how, where and with what professionals women are accompanied and assisted during pregnancy, childbirth and postpartum.
Some key aspects in care models include:
- the focus on women’s individual needs, values and preferences and their experience,
- who provides care and whether continuity of care is offered,
- the philosophy that professionals adopt regarding the pregnancy, childbirth and postpartum process and,
- the physical environment in which this attention takes place.
Continuity of care is an essential component of women-centered models, which involves support during pregnancy, childbirth and the postpartum period by the midwife or team of midwives, with the collaboration of obstetricians, neonatologists or other specialists. . As needed. Midwives are, or should be, the leaders and main providers of care in models intended for women with normal or low- and medium-risk pregnancies, as well as in births where complications are not anticipated.
There are alternatives to conventional hospital birth and there are different care models, including planned home birth and birth center birth. Planned home birth should be distinguished from birth that happens accidentally at home. In our country it is a private service offered, mostly, by midwives. Women who choose this option meet low-risk requirements and it is the only model, in our context, in which care is guaranteed by the same midwife or team of midwives during pregnancy, childbirth and the postpartum period. Birth centers are spaces that can be inside or outside a hospital, similar to a home and where a team of midwives provides care and these units manage with the support of the obstetrics and neonatology team. In Spain, and within the public health system, there are two centers: the hospital Sant Joan de Déu de Martorell and Casa Laietània, in the Alemanes Trias Hospitalboth in Catalonia.
The thesis was carried out by compendium of articles. The three studies were published in first quartile journals. The thesis concludes that women who chose to give birth at home or in a birth center had a greater probability of spontaneous birth, of giving birth in different positions, of using non-pharmacological analgesia measures, of being accompanied by whomever they chose, and a lower probability of an instrumented delivery, episiotomy and epidural analgesia (Alcaraz-Vidal, L. 2024a; Alcaraz-Vidal, L. 2024b). Newborns born to women in the home birth group were less likely to be admitted to the Neonatal Intensive Care Unit (NICU) (Alcaraz-Vidal, L. 2024a). There were no differences in babies born in the birth center and those born in the obstetric unit in terms of Apgar score less than 7 at five minutes or in terms of admissions to the NICU (Alcaraz-Vidal, L. 2024b). Nulliparous women had a higher percentage of transfers in the three groups. The most frequent reason for transfer was the need for epidural analgesia (Alcaraz-Vidal, L. 2024b). Regarding the experience of home birth, the women who chose it, in general, had very positive experiences that were related to the participation of women in decision-making and in the birth process in general and the continuous support of the midwives. A worse home birth experience was related to transfer to the hospital during delivery, duration of labor greater than 12 hours, and perineal trauma (Alcaraz-Vidal, L. 2024c).
Lucía Alcaraz Vidal, presenting her project at the XIII EvaluAES Workshop held at the University of Seville
