Midwife-led maternity care in Ireland – a retrospective cohort study

Abstract

Background: Midwife-led maternity care is shown to be safe for women with low-risk during pregnancy. In Ireland, two midwife-led units (MLUs) were introduced in 2004 when a randomised controlled trial (the MidU study) was performed to compare MLU care with consultant-led care (CLU). Following study completion the two MLUs have remained as a maternity care option in Ireland. The aim of this study was to evaluate maternal and neonatal outcomes and transfer rates during six years in the larger of the MLU sites. Methods: MLU data for the six years 2008-2013 were retrospectively analysed, following ethical approval. Rates of transfer, reasons for transfer, mode of birth, and maternal and fetal outcomes were assessed. Linear-by-Linear Association trend analysis was used for categorical data to evaluate trends over the years and one-way ANOVA was used when comparing continuous variables. Results: During the study period, 3,884 women were registered at the MLU. The antenatal transfer rate was 37.4% and 2,410 women came to labour in the MLU. Throughout labour and birth, 567 women (14.6%) transferred to the CLU, of which 23 were transferred after birth due to need for suturing or postpartum hemorrhage. The most common reasons for intrapartum transfer were meconium stained liquor/abnormal fetal heart rate (30.3%), delayed labour progress in first or second stage (24.9%) and woman's wish for epidural analgesia (15.1%). Of the 1,903 babies born in the MLU, 1,878 (98.7%) were spontaneous vaginal births and 25 (1.3%) were instrumental (ventouse/ forceps). Only 25 babies (1.3%) were admitted to neonatal intensive care unit. All spontaneous vaginal births from the MLU registered population, occurring in the study period in both the MLU and CLU settings (n = 2,785), were compared. In the MLU more often 1-2 midwives (90.9% vs 69.7%) cared for the women during birth, more women had three vaginal examinations or fewer (93.6% vs 79.9%) and gave birth in an upright position (standing, squatting or kneeling) (52.0% vs 9.4%), fewer women had an amniotomy (5.9% vs 25.9%) or episiotomy (3.4% vs 9.7%) and more women had a physiological management of third stage of labour (50.9% vs 4.6%). Conclusions: Midwife-led care is a safe option that could be offered to a large proportion of healthy pregnant women. With strict transfer criteria there are very few complications during labour and birth. Maternity units without the option of MLU care should consider its introduction.

The “Cocoon,” first alongside midwifery‐led unit within a Belgian hospital: Comparison of the maternal and neonatal outcomes with the standard obstetric unit over 2 years

“…The intrapartum transfer rate of the Cocoon women lies within the intermediate range. In the literature, transfer rates vary from 12% to 31.3% . In their study of 16 710 patients, the Birthplace in England Collaborative Group found a transfer rate from an alongside midwifery unit of 21.2% before delivery .…”

“…In the literature, transfer rates vary from 12% 20 to 31.3%. 2,12,16,[20][21][22] In their study of 16 710 patients, the Birthplace in England Collaborative Group found a transfer rate from an alongside midwifery unit of 21.2% before delivery. 12 Nulliparous women were more likely to be transferred from a non-obstetric unit setting to an obstetric unit (36 to 45%) than multiparous women (9%-13%).…”

Factors influencing utilisation of ‘free-standing’ and ‘alongside’ midwifery units for low-risk births in England: a mixed-methods study

“…3,[17][18][19][20][21] There are also several observational studies into AMUs, with comparison OU outcomes. 19,22,23 The limited contemporary research into the comparative clinical outcomes for FMUs and OUs includes prospective studies, [24][25][26] a retrospective study 27 and population-based cohort studies. 19,28 There are also studies reporting only MU clinical outcomes, with no OU comparison outcomes from the same context.…”

Risk and the politics of boundary work: preserving autonomous midwifery in the Netherlands

“…Several researchers have argued that the empirical evidence about risk in MNC that is often used to inform policy is not objective, but interpreted through the lens of one's beliefs and interests (see, for example, Dencker, Smith, McCann, & Begley, 2017;de Vries, Paruchuri, Lorenz, & Vedam, 2013;Healy, Humphreys, & Kennedy, 2016b;Lane, 2015;Roome, Hartz, Tracy, & Welsh, 2016). Studies have also shown that use of medical interventions in MNC is associated with provider attitude rather than evidence, resulting in undesired practice variation and negatively affecting care outcomes (Klein et al, 2009;Offerhaus et al, 2015;Rivo et al, 2018;White VanGompel, Main, Tancredi, & Melnikow, 2018).…”