BackgroundIntrapartum complications and the use of obstetric interventions are more common in primiparous childbirth than in multiparous childbirth, leading to concern about out of hospital birth for primiparous women. The purpose of this study was to determine whether the effect of birthplace on perinatal and maternal morbidity and the use of obstetric interventions differed by parity among low-risk women intending to give birth in a freestanding midwifery unit or in an obstetric unit in the North Denmark Region.MethodsThe study is a secondary analysis of data from a matched cohort study including 839 low-risk women intending birth in a freestanding midwifery unit (primary participants) and 839 low-risk women intending birth in an obstetric unit (individually matched control group). Analysis was by intention-to-treat. Conditional logistic regression analysis was applied to compute odds ratios and effect ratios with 95% confidence intervals for matched pairs stratified by parity.ResultsOn no outcome did the effect of birthplace differ significantly between primiparous and multiparous women. Compared with their counterparts intending birth in an obstetric unit, both primiparous and multiparous women intending birth in a freestanding midwifery unit were significantly more likely to have an uncomplicated, spontaneous birth with good outcomes for mother and infant and less likely to require caesarean section, instrumental delivery, augmented labour or epidural analgesia (although for caesarean section this trend did not attain statistical significance for multiparous women). Perinatal outcomes were comparable between the two birth settings irrespective of parity. Compared to multiparas, transfer rates were substantially higher for primiparas, but fell over time while rates for multiparas remained stable.ConclusionsFreestanding midwifery units appear to confer significant advantages over obstetric units to both primiparous and multiparous mothers, while their infants are equally safe in both settings. Our findings thus support the provision of care in freestanding midwifery units as an alternative to care in obstetric units for all low-risk women regardless of parity. In view of the global rise in caesarean section rates, we consider it an important finding that freestanding midwifery units show potential for reducing first-birth caesarean.Electronic supplementary materialThe online version of this article (doi:10.1186/s12884-016-1208-1) contains supplementary material, which is available to authorized users.

IntroductionMaternal mental health conditions have been shown to affect perinatal outcomes negatively. However, knowledge on the impact of different types and severities of maternal mental health conditions is needed. The objective of this study was to determine the association between maternal mental health status and perinatal health outcomes in the infant.Material and methodsThis register‐based cohort study included all live‐born infants in Denmark born between 2000 and 2016. Exposed infants were grouped based on whether the mothers received mental health care in primary care settings only (minor conditions) or required specialized psychiatric intervention (moderate–severe conditions) within 12 months before childbirth. Modified Poisson regression analyses were applied to produce adjusted risk ratios (aRRs) for each perinatal outcome of interest. The primary outcomes were neonatal mortality, 5‐minute Apgar scores <7 and <4 and newborn hospital admission during the neonatal period. Secondary outcomes included several neonatal morbidities such as respiratory distress syndrome and abstinence syndrome.ResultsA total of 952 071 infants were included in the analysis; 4.0% had mothers with minor mental health conditions and 2.9% had mothers with moderate–severe conditions. The risk of neonatal death in exposed infants was aRR 1.08 (95% CI 0.93–1.27) for minor mental health conditions and aRR 0.93 (95% CI 0.78–1.11) for moderate–severe conditions. Both exposure groups had increased risks of 5‐minute Apgar scores <7 (minor: aRR 1.28, 95% CI 1.16–1.41; moderate–severe: aRR 1.49, 95% CI 1.34–1.66); 5‐minute Apgar scores <4 (minor: aRR 1.10, 95% CI 0.93–1.30; moderate–severe: aRR 1.18, 95% CI 0.98–1.43), and hospital admission during the neonatal period (minor: aRR 1.20, 95% CI 1.17–1.23; moderate–severe: aRR 1.22, 95% CI 1.19–1.26) along with several neonatal morbidities. An explicit high risk was seen for abstinence syndrome (minor: aRR 10.30, 95% CI 8.40–12.63; moderate–severe: aRR 12.13, 95% CI 10.17–15.67).ConclusionsInfants of mothers with moderate–severe and minor mental health conditions were at increased risks of multiple adverse perinatal outcomes. Effective supportive interventions to improve outcomes in both groups are needed.

Intramuscular myxoma (IM) is a rare benign tumour. It may occur at any age but most commonly occurs among older women. The preoperative diagnosis of IM is complicated. The diagnosis can only be definitively established by histopathological examination. The treatment of choice is radical surgical excision. We report a case of a 41-year-old woman with an IM of the biceps brachii muscle.

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