Evaluating Maternity Units: a prospective cohort study of freestanding midwife-led primary maternity units in New Zealand—clinical outcomes

Abstract

ObjectiveTo compare maternal and neonatal birth outcomes and morbidities associated with the intention to give birth in a freestanding primary level midwife-led maternity unit (PMU) or tertiary level obstetric-led maternity hospital (TMH) in Canterbury, Aotearoa/New Zealand.DesignProspective cohort study.Participants407 women who intended to give birth in a PMU and 285 women who intended to give birth at the TMH in 2010–2011. All of the women planning a TMH birth were ‘low risk’, and 29 of the PMU cohort had identified risk factors.Primary outcomesMode of birth, Apgar score of less than 7 at 5 min and neonatal unit admission. Secondary outcomes: labour onset, analgesia, blood loss, third stage of labour management, perineal trauma, non-pharmacological pain relief, neonatal resuscitation, breastfeeding, gestational age at birth, birth weight, severe morbidity and mortality.ResultsWomen who planned a PMU birth were significantly more likely to have a spontaneous vaginal birth (77.9%vs62.3%, adjusted OR (AOR) 1.61, 95% CI 1.08 to 2.39), and significantly less likely to have an instrumental assisted vaginal birth (10.3%vs20.4%, AOR 0.59, 95% CI 0.37 to 0.93). The emergency and elective caesarean section rates were not significantly different (emergency: PMU 11.6% vs TMH 17.5%, AOR 0.88, 95% CI 0.55 to 1.40; elective: PMU 0.7% vs TMH 2.1%, AOR 0.34, 95% CI 0.08 to 1.41). There were no significant differences between the cohorts in rates of 5 min Apgar score of <7 (2.0%vs2.1%, AOR 0.82, 95% CI 0.27 to 2.52) and neonatal unit admission (5.9%vs4.9%, AOR 1.44, 95% CI 0.70 to 2.96). Planning to give birth in a primary unit was associated with similar or reduced odds of intrapartum interventions and similar odds of all measured neonatal well-being indicators.ConclusionsThe results of this study support freestanding midwife-led primary-level maternity units as physically safe places for well women to plan to give birth, with these women having higher rates of spontaneous vaginal births and lower rates of interventions and their associated morbidities than those who planned a tertiary hospital birth, with no differences in neonatal outcomes.

Comparing perinatal outcomes for healthy pregnant women presenting at primary and tertiary settings in South Auckland: A retrospective cohort study

“…The intrapartum and immediate postpartum (within 12 hours of birth) transfer rate was 9.3% (n=104), lower than the 19% (n=6002), 21.9% (n=2,468) and 17.3% (n=70) reported by Bailey (2017), Hollowell et al (2011) and Grigg et al (2017), respectively. However, these studies either included maternal and neonatal transfers up to 48 hours (Grigg et al, 2017) or did not define the timeframe (Bailey, 2017;Hollowell et al, 2011). Sixty-nine percent of the transfers were primigravid women.…”

“…Further prospective, retrospective and population based studies from Denmark (Overgaard, Møller, Fenger-Grøn, Knudsen, & Sandall, 2011), the Netherlands (Wiegerinck et al, 2015), Australia (Homer et al, 2014;Laws, Tracy, & Sullivan, 2010;Monk, Tracy, Foureur, Grigg, & Tracy, 2014), United States of America (Stapleton, Osborne, & Illuzzi, 2013) and NZ (Bailey, 2017;Davis et al, 2011;Grigg et al, 2017) reported significantly fewer obstetric interventions (such as instrumental birth, emergency caesarean section, labour augmentation, episiotomy) for mothers and no difference in neonatal mortality and morbidity for babies, when choosing midwifery-led settings (home and PMU) over obstetric-led hospitals. In contrast, population-based studies from the USA report higher neonatal mortality for babies born at home (Grünebaum et al, 2014;Wax et al, 2010) and a higher prevalence of Apgars of 0 at 5-min and neurological dysfunction in babies born at home or at a PMU (Grünebaum et al, 2014) compared to births at a TMH.…”

Factors associated with low Apgar in newborns in birth center

“…newborn care was performed by obstetric nurse or obstetrician and hospital units that had the presence of physician (11) . Regarding the prevalence of Apgar score < 7 at the fifth minute, the international literature shows lower prevalences, but with no significant differences for care in Normal Birth Center, when compared with the care for low-risk women in the hospital (12)(13)(14)(15) . However, the prevalences are higher than in the present study.…”

“…However, the prevalences are higher than in the present study. In extra-hospital NDC in Australia and New Zealand, the prevalence was 1.2% and 2%, respectively (12)(13) . In Denmark, the prevalence of Apgar score < 7 at the first minute is below 2.5% (14) .…”

Model of Care and Chance of Spontaneous Vaginal Birth: A Prospective, Multicenter Matched-Pair Analysis From North Rhine-Westphalia

“…Compared to standard obstetric care, advantages of midwife-led models of care (MLC) have been reported, including an increased vaginal birth rate with less interventions, and a shorter duration of labor (1)(2)(3)(4)(5)(6)(7)(8)(9)(10)(11). MLCs comprise a spectrum of care which include home births (HB), births in freestanding midwifery units (FMU), and alongside midwifery units (AMU).…”