General obstetrics: Does size matter? A population‐based study of birth in lower volume maternity hospitals for low risk women

Abstract

Objective To study the association between volume of hospital births per annum and birth outcome for low risk women.Design Population‐based study using the National Perinatal Data Collection (NPDC).Setting Australia.Participants Of 750,491 women who gave birth during 1999–2001, there were 331,147 (47.14%) medically ‘low risk’ including 132,696 (40.07%) primiparae and 198,451 (59.93%) multiparae.Methods The frequency of each birth and infant outcome was described according to the size of the hospital where birth took place. We investigated whether unit size (defined by volume) was an independent risk factor for each outcome factor using public hospitals with greater than 2000 births per annum as a reference point.Main outcome measures Rates of intervention at birth and neonatal mortality for low risk women in relation to hospitals with <100, 100–500, 501–1000, 1001–2000 and >2001 births per annum.Results Neonatal death was less likely in hospitals with less than 2000 births per annum regardless of parity. For multiparous low risk women in hospitals of 100 and 500 births per annum compared with hospitals of >2000 births per annum the adjusted odds of neonatal mortality [adjusted odds ratio (AOR) 0.36; 99% confidence interval (CI) 0.14–0.93]. For low risk primiparous women in hospitals with less than 100 births per annum, there were lower rates of induction of labour (AOR 0.62; 99% CI 0.54–0.73); intrathecal analgesia/anaesthesia (AOR 0.34; 99% CI 0.28–0.42); instrumental birth (AOR 0.80; 99% CI 0.69–0.93); caesarean section after labour (AOR 0.59; 99% CI 0.49–0.72) and admission to a neonatal unit (AOR 0.15; 99% CI 0.10–0.22) and for low risk multiparous women in hospitals with less than 100 births per annum: induction (AOR 0.69; 99% CI 0.62–0.76); intrathecal analgesia/anaesthesia (AOR 0.32; 99% CI 0.29–0.36); instrumental birth (AOR 0.52; 99% CI 0.41–0.67); caesarean section after labour (AOR 0.41; 99% CI 0.33–0.52); and admission to a neonatal unit (AOR 0.09; 99% CI 0.07–0.12).Conclusions In Australia, lower hospital volume is not associated with adverse outcomes for low risk women.

Babies born before arrival to hospital and maternity unit closures in Queensland and Australia

“…Typically it was the smaller units, performing less than 500 births, which closed (n = 255 nationally). It is likely that these were in rural and remote areas 1,3,8,44 though this cannot be determined from this data. The findings demonstrate the centralisation of maternity services, in Queensland in particular, where the number of hospitals performing more than 2001 births doubled (from 5 to 10).…”

“…The decline of maternity units is a long-term trend which has been reported in the literature across many countries and results in some women living considerable distances from services, especially those in rural and remote areas. [1][2][3][4]7,8,10,11,23,31,32,35,45 This study has identified a significant inverse association between the supply of maternity units and the BBA rate in Queensland and Australia. Identifying the exact geographic location of the mothers usual residence was not possible without geocoded data, which is not freely available.…”

Australian Aboriginal kinship: A means to enhance maternal well-being

“…The reopening of small units needs to be accompanied by strategies to enable health professionals, including midwives, to practise confidently and safely as, contrary to commonly held beliefs, lower hospital volume has not been shown to be associated with increased adverse outcomes for healthy women. 25 …”

Systems Factors in Obstetric Care

“…Previous research has analyzed hospital obstetric volume, [1][2][3][4][5] institutional characteristics (eg, academic affiliation), 6 and timing of delivery (hour, day, and month). [7][8][9][10][11][12][13] Although results vary, each of these factors has been associated with both the practice of obstetrics and the frequency of adverse birth outcomes.…”