Vanessa Scarf is the project coordinator at UTS for Birthplace in Australia, a study being undertaken by researchers from around the country comparing neonatal mortality and morbidity associated with low-risk births at home, birth centres or stand-alone midwifery units, compared with births in standard labour wards.
A practicing midwife for over 20 years, Vanessa has taught undergraduate midwives at UTS.
For her PhD, she is studying the comparative costs of giving birth in domestic or hospital settings in NSW, which is part of an NHMRC-funded project.
- Women’s health
- Perinatal health
- Linked data analysis
Scarf, V.L., Rossiter, C., Vedam, S., Dahlen, H.G., Ellwood, D., Forster, D., Foureur, M.J., McLachlan, H., Oats, J., Sibbritt, D., Thornton, C. & Homer, C.S.E. 2018, 'Maternal and perinatal outcomes by planned place of birth among women with low-risk pregnancies in high-income countries: A systematic review and meta-analysis.', Midwifery, vol. 62, pp. 240-255.View/Download from: Publisher's site
The comparative safety of different birth settings is widely debated. Comparing research across high-income countries is complex, given differences in maternity service provision, data discrepancies, and varying research techniques and quality. Studies of births planned at home or in birth centres have reported both better and poorer outcomes than planned hospital births. Previous systematic reviews have focused on outcomes from either birth centres or home births, with inconsistent attention to quality appraisal. Few have attempted to synthesise findings.To compare maternal and perinatal outcomes from different places of birth via a systematic review of high-quality research, and meta-analysis of appropriate data (Prospero registration CRD42016042291).Reviewers searched CINAHL, Embase, Maternity and Infant Care, Medline and PsycINFO databases to identify studies comparing selected outcomes by place of birth among women with low-risk pregnancies in high-income countries. They critically appraised identified studies using an instrument specific to birth place research and then combined outcome data via meta-analysis, using RevMan software.Twenty-eight articles met inclusion criteria, yielding comparative data on perinatal mortality, mode of birth, maternal morbidity and/or NICU admissions. Meta-analysis indicated that women planning hospital births had statistically significantly lower odds of normal vaginal birth than in other planned settings. Women experienced severe perineal trauma or haemorrhage at a lower rate in planned home births than in obstetric units. There were no statistically significant differences in infant mortality by planned place of birth, although most studies had limited statistical power to detect differences for rare outcomes. Differences in location, context, quality and design of identified studies render results subject to variation.High-quality evidence about low-risk pregnancies indicates that place of birth had no statistically signi...
Vedam, S., Rossiter, C., Homer, C.S.E., Stoll, K. & Scarf, V.L. 2017, 'The ResQu Index: A new instrument to appraise the quality of research on birth place.', PLoS ONE, vol. 12, no. 8, pp. 1-19.View/Download from: UTS OPUS or Publisher's site
Place of birth is a known determinant of health care outcomes, interventions and costs. Many studies have examined the maternal and perinatal outcomes when women plan to give birth in hospitals compared with births in birth centres or at home. However, these studies vary substantially in rigour; assessing their quality is challenging. Existing research appraisal tools do not always capture important elements of study design that are critical when comparing outcomes by planned place of birth. To address this deficiency, we aimed to develop a reliable instrument to rate the quality of primary research on maternal and newborn outcomes by place of birth.The instrument development process involved five phases: 1) generation of items and a weighted scoring system; 2) content validation via a quantitative survey and a modified Delphi process with an international, multi-disciplinary panel of experts; 3) inter-rater consistency; 4) alignment with established research appraisal tools; and 5) pilot-testing of instrument usability.A Birth Place Research Quality Index (ResQu Index) was developed comprising 27 scored items that are summed to generate a weighted composite score out of 100 for studies comparing planned place of birth. Scale content validation indices were .89 for clarity, .94 for relevance and .90 for importance. The Index demonstrated substantial inter-rater consistency; pilot-testing confirmed feasibility and user-friendliness.The ResQu Index is a reliable instrument to evaluate the quality of design, methods and interpretation of reported outcomes from research about place of birth. Higher-scoring studies have greater potential to inform evidence-based selection of birth place by clinicians, policy makers, and women and their families. The Index can also guide the design of future research on place of birth.
Scarf, V., Catling, C., Viney, R. & Homer, C.S. 2016, 'Costing alternative birth settings for women at low risk of complications: A systematic review', PLoS One, vol. 11, no. 2, pp. 1-17.View/Download from: UTS OPUS or Publisher's site
There is demand from women for alternatives to giving birth in a standard hospital setting however access to these services is limited. This systematic review examines the literature relating to the economic evaluations of birth setting for women at low risk of complications.
Searches of the literature to identify economic evaluations of different birth settings of the following electronic databases: MEDLINE, CINAHL, EconLit, Business Source Complete and Maternity and Infant care. Relevant English language publications were chosen using keywords and MeSH terms between 1995 and 2015. Inclusion criteria included studies focussing on the comparison of birth setting. Data were extracted with respect to study design, perspective, PICO principles, and resource use and cost data.
Eleven studies were included from Australia, Canada, the Netherlands, Norway, the USA, and the UK. Four studies compared costs between homebirth and the hospital setting and the remaining seven focussed on the cost of birth centre care and the hospital setting. Six studies used a cost-effectiveness analysis and the remaining five studies used cost analysis and cost comparison methods. Eight of the 11 studies found a cost saving in the alternative settings. Two found no difference in the cost of the alternative settings and one found an increase in birth centre care.
There are few studies that compare the cost of birth setting. The variation in the results may be attributable to the cost data collection processes, difference in health systems and differences in which costs were included. A better understanding of the cost of birth setting is needed to inform policy makers and service providers.
Homer, C.S., Scarf, V.L., Catling, C. & Davis, D. 2014, 'Culture-based versus risk-based screening for the prevention of group B streptococcal disease in newborns: A review of national guidelines', Women and Birth, vol. 27, no. 1, pp. 46-51.View/Download from: Publisher's site
Background: Maternal colonisation with group B streptococcus (GBS) is recognised as the most frequent cause of severe early onset infection in newborns. National and international guidelines outline two approaches to the prevention of early onset disease in the neonate: risk based management and antenatal culture-based screening. We undertook an analysis of existing national and international guidelines in relation to GBS in pregnancy using a standardised and validated instrument to highlight the different recommended approaches to care.
Homer, C.S., Thornton, T., Scarf, V.L., Ellwood, D., Oats, J., Foureur, M., Sibbritt, D., McLachlan, H.L., Forster, D. & Dahlen, H. 2014, 'Birthplace in New South Wales, Australia: an analysis of perinatal outcomes using routinely collected data', BMC Pregnancy and Childbirth, vol. 14, pp. 206-206.View/Download from: UTS OPUS or Publisher's site
Background: The outcomes for women who give birth in hospital compared with at home are the subject of
ongoing debate. We aimed to determine whether a retrospective linked data study using routinely collected data
was a viable means to compare perinatal and maternal outcomes and interventions in labour by planned place of
birth at the onset of labour in one Australian state.
Methods: A population-based cohort study was undertaken using routinely collected linked data from the New
South Wales Perinatal Data Collection, Admitted Patient Data Collection, Register of Congenital Conditions, Registry
of Birth Deaths and Marriages and the Australian Bureau of Statistics. Eight years of data provided a sample size of
258,161 full-term women and their infants. The primary outcome was a composite outcome of neonatal mortality
and morbidity as used in the Birthplace in England study.
Results: Women who planned to give birth in a birth centre or at home were significantly more likely to have a
normal labour and birth compared with women in the labour ward group. There were no statistically significant
differences in stillbirth and early neonatal deaths between the three groups, although we had insufficient statistical
power to test reliably for these differences.
Conclusion: This study provides information to assist the development and evaluation of different places of birth
across Australia. It is feasible to examine perinatal and maternal outcomes by planned place of birth using routinely
collected linked data, although very large data sets will be required to measure rare outcomes associated with
place of birth in a low risk population, especially in countries like Australia where homebirth rates are low.
Sibbritt, D., Catling, C., Scarf, V.L. & Homer, C.S. 2013, 'The profile of women who consult midwives in Australia', Women and Birth, vol. 26, no. 4, pp. 240-245.View/Download from: UTS OPUS or Publisher's site
Background: There is no Australian data on the characteristics of women who consult with midwives. Aim: To determine the profile of women who consult midwives in Australia. Methods: This cross-sectional research was conducted as part of the Australian Longitudinal Study on Womens Health (ALSWH). Participants were the younger (3136 years) cohort of the ALSWH who completed a survey in 2009, and indicated that they were currently pregnant (n = 801). The main outcome measure was consultation with a midwife.