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.
Can supervise: YES
- Women’s health
- Perinatal health
- Linked data analysis
Scarf, V, Yu, S, Foureur, M, Viney, R, Dahlen, H, Lavis, L & Homer, C 2020, 'The cost of vaginal birth at home, in a birth centre or in a hospital setting in New South Wales: A micro-costing study', Women and Birth, vol. 33, no. 3, pp. 286-293.View/Download from: Publisher's site
Coates, D, Makris, A, Catling, C, Henry, A, Scarf, V, Watts, N, Fox, D, Thirukumar, P, Wong, V, Russell, H & Homer, C 2020, 'A systematic scoping review of clinical indications for induction of labour.', PloS one, vol. 15, no. 1.View/Download from: Publisher's site
BACKGROUND:The proportion of women undergoing induction of labour (IOL) has risen in recent decades, with significant variation within countries and between hospitals. The aim of this study was to review research supporting indications for IOL and determine which indications are supported by evidence and where knowledge gaps exist. METHODS:A systematic scoping review of quantitative studies of common indications for IOL. For each indication, we included systematic reviews/meta-analyses, randomised controlled trials (RCTs), cohort studies and case control studies that compared maternal and neonatal outcomes for different modes or timing of birth. Studies were identified via the databases PubMed, Maternity and Infant Care, CINAHL, EMBASE, and ClinicalTrials.gov from between April 2008 and November 2019, and also from reference lists of included studies. We identified 2554 abstracts and reviewed 300 full text articles. The quality of included studies was assessed using the RoB 2.0, the ROBINS-I and the ROBIN tool. RESULTS:68 studies were included which related to post-term pregnancy (15), hypertension/pre-eclampsia (15), diabetes (9), prelabour rupture of membranes (5), twin pregnancy (5), suspected fetal compromise (4), maternal elevated body mass index (BMI) (4), intrahepatic cholestasis of pregnancy (3), suspected macrosomia (3), fetal gastroschisis (2), maternal age (2), and maternal cardiac disease (1). Available evidence supports IOL for women with post-term pregnancy, although the evidence is weak regarding the timing (41 versus 42 weeks), and for women with hypertension/preeclampsia in terms of improved maternal outcomes. For women with preterm premature rupture of membranes (24-37 weeks), high-quality evidence supports expectant management rather than IOL/early birth. Evidence is weakly supportive for IOL in women with term rupture of membranes. For all other indications, there were conflicting findings and/or insufficient power to provide definitive eviden...
Cheah, SL, Scarf, VL, Rossiter, C, Thornton, C & Homer, CSE 2019, 'Creating the first national linked dataset on perinatal and maternal outcomes in Australia: Methods and challenges.', Journal of biomedical informatics, vol. 93.View/Download from: Publisher's site
BACKGROUND:Data linkage offers a powerful mechanism for examining healthcare outcomes across populations and can generate substantial robust datasets using routinely collected electronic data. However, it presents methodological challenges, especially in Australia where eight separate states and territories maintain health datasets. This study used linked data to investigate perinatal and maternal outcomes in relation to place of birth. It examined data from all eight jurisdictions regarding births planned in hospitals, birth centres and at home. Data linkage enabled the first Australia-wide dataset on birth outcomes. However, jurisdictional differences in data collection created challenges in obtaining comparable cohorts of women with similar low-risk pregnancies in all birth settings. The objective of this paper is to describe the techniques for managing previously linked data, and specifically for ensuring the resulting dataset contained only low-risk pregnancies. METHODS:This paper indicates the procedures for preparing and merging linked perinatal, inpatient and mortality data from different sources, providing technical guidance to address challenges arising in linked data study designs. RESULTS:We combined data from eight jurisdictions linking four collections of administrative healthcare and civil registration data. The merging process ensured that variables were consistent, compatible and relevant to study aims. To generate comparable cohorts for all three birth settings, we developed increasingly complex strategies to ensure that the dataset eliminated women with pregnancies at risk of complications during labour and birth. It was then possible to compare birth outcomes for comparable samples, enabling specific examination of the impact of birth setting on maternal and infant safety across Australia. CONCLUSIONS:Data linkage is a valuable resource to enhance knowledge about birth outcomes from different settings, notwithstanding methodological challenges...
Scarf, VL, Viney, R, Yu, S, Foureur, M, Rossiter, C, Dahlen, H, Thornton, C, Cheah, SL & Homer, CSE 2019, 'Mapping the trajectories for women and their babies from births planned at home, in a birth centre or in a hospital in New South Wales, Australia, between 2000 and 2012', BMC Pregnancy and Childbirth, vol. 19, no. 1.View/Download from: Publisher's site
Homer, CSE, Cheah, SL, Rossiter, C, Dahlen, HG, Ellwood, D, Foureur, MJ, Forster, DA, McLachlan, HL, Oats, JJN, Sibbritt, D, Thornton, C & Scarf, VL 2019, 'Maternal and perinatal outcomes by planned place of birth in Australia 2000 - 2012: a linked population data study.', BMJ open, vol. 9, no. 10.View/Download from: Publisher's site
OBJECTIVE:To compare perinatal and maternal outcomes for Australian women with uncomplicated pregnancies according to planned place of birth, that is, in hospital labour wards, birth centres or at home. DESIGN:A population-based retrospective design, linking and analysing routinely collected electronic data. Analysis comprised χ2 tests and binary logistic regression for categorical data, yielding adjusted ORs. Continuous data were analysed using analysis of variance. SETTING:All eight Australian states and territories. PARTICIPANTS:Women with uncomplicated pregnancies who gave birth between 2000 and 2012 to a singleton baby in cephalic presentation at between 37 and 41 completed weeks' gestation. Of the 1 251 420 births, 1 171 703 (93.6%) were planned in hospital labour wards, 71 505 (5.7%) in birth centres and 8212 (0.7%) at home. MAIN OUTCOME MEASURES:Mode of birth, normal labour and birth, interventions and procedures during labour and birth, maternal complications, admission to special care/high dependency or intensive care units (mother or infant) and perinatal mortality (intrapartum stillbirth and neonatal death). RESULTS:Compared with planned hospital births, the odds of normal labour and birth were over twice as high in planned birth centre births (adjusted OR (AOR) 2.72; 99% CI 2.63 to 2.81) and nearly six times as high in planned home births (AOR 5.91; 99% CI 5.15 to 6.78). There were no statistically significant differences in the proportion of intrapartum stillbirths, early or late neonatal deaths between the three planned places of birth. CONCLUSIONS:This is the first Australia-wide study to examine outcomes by planned place of birth. For healthy women in Australia having an uncomplicated pregnancy, planned births in birth centres or at home are associated with positive maternal outcomes although the number of homebirths was small overall. There were no significant differences in the perinatal mortality rate, although the absolute numbers of deaths w...
Scarf, VL, Rossiter, C, Vedam, S, Dahlen, HG, Ellwood, D, Forster, D, Foureur, MJ, McLachlan, H, Oats, J, Sibbritt, D, Thornton, C & Homer, CSE 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
BACKGROUND: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. OBJECTIVE: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). DESIGN: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. FINDINGS: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. CONCLUSIONS AND IMPLICATIONS FOR PRACTICE:High-quality evidence ...
Cummins, AM, Smith, R, Catling, C, Watts, N, Scarf, V, Fox, D & Gray, J 2018, 'Midwifery Graduate Attributes: A model for curriculum development and education.', Midwifery, vol. 61, pp. 66-69.View/Download from: Publisher's site
Models of midwifery education need to evolve to meet changing needs of the profession. This requires a constant process of review and re-evaluation of curricula. Courses that lead to midwifery registration must not only meet national and international standards, but many also commit to producing graduates who meet course-specific graduate attributes. These attributes differ between models of education and courses and are pivotal in providing clear direction for the development of higher level abilities in graduates. Visionary graduate attributes provide the opportunity to prepare graduates to function and flourish in a fast changing social and professional environment and to prepare them for a future that is largely unknown (Bowden et al., 2000).
The University of Technology Sydney (UTS) has embraced the concept of graduate attributes and all graduates are expected to demonstrate capability in both University and course-specific attributes. The UTS model of learning provides a framework for practice oriented learning that aligns graduate attributes and curriculum design. The model is focussed on three distinctive areas, practice oriented education situated in a global workplace through learning that is research inspired and integrated (UTS 2017). Each course offered by UTS has embedded graduate attributes that reflect the overall aim of the course. These provide important information for students, the public and future employers as to what personal, professional and intellectual attributes to expect from a graduate of that course.
Commencing in 2012, the midwifery team undertook a project to develop visionary attributes for midwifery graduates and this paper describes and discusses the development and implementation process of the graduate attributes model.
Vedam, S, Rossiter, C, Homer, CSE, Stoll, K & Scarf, VL 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: 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, CS 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: 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, CS, Thornton, T, Scarf, VL, Ellwood, D, Oats, J, Foureur, M, Sibbritt, D, McLachlan, HL, 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: 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.
Homer, CS, Scarf, VL, 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.
Scarf, V, Foureur, M, Crisp, J, Burton, G & Yu, N 2013, 'Efficacy of mindfulness based stress reduction (MBSR) on the sense of wellbeing of healthcare staff: A pilot study', WOMEN AND BIRTH, vol. 26, no. 1, pp. S17-S17.View/Download from: 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.
Yu, S, Fiebig, DG, Viney, R, Scarf, V & Homer, C 2019, 'Private Provider Incentives in Health Care: The Case of Birth Interventions', iHEA 2019 Congress: New Heights in Health Economics, Basel, Switzerland.
Scarf, V, Viney, R, Cheah, S & Homer, C 2018, 'Estimated costs associated with birth at home, in a birth centre or in a hospital: a micro-costing', WOMEN AND BIRTH, ELSEVIER SCIENCE BV, pp. S51-S52.View/Download from: Publisher's site