Outcomes associated with planned place of birth among women with low-risk pregnancies

Hutton, Eileen K.; Cappelletti, Adriana; Reitsma, Angela; Simioni, Julia; Horne, Jordyn; McGregor, Caroline; Ahmed, Rashid

doi:10.1503/cmaj.150564

Cited by 86 publications

(72 citation statements)

References 7 publications

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“…Further work is required. It is important to note that overall prevalence of intervention was higher in the hospital cohort (augmentation, epidural analgesia, assisted vaginal, and cesarean birth), which supports international literature on lower intervention rates in out‐of‐hospital births 7, 10, 13…”

Section: Discussionsupporting

confidence: 76%

“…Hutton et al's much larger study of 11,493 planned home births in Ontario had a 24.4% rate of hospital transport, which was significantly lower in multiparous women (14.3%) than in nulliparous women (45.6%) 13. Ontario birth center overall transport rates were higher than Hutton et al's study but were lower for nulliparous women.…”

Section: Discussionmentioning

confidence: 79%

“…Stapleton et al demonstrated an intrapartum fetal mortality rate of 0.47 per 1000 among birth center admissions and a neonatal mortality rate of 0.40 per 1000, excluding anomalies 5. Hutton et al13 found no difference in the composite outcome of stillbirth, neonatal death, or morbidity with an absolute risk of 0.39% in both the home and hospital groups studied. It is therefore not surprising that in this small cohort that we report on there were minimal cases of serious fetal or newborn morbidity.…”

Section: Discussionmentioning

confidence: 96%

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Outcomes for the First Year of Ontario's Birth Center Demonstration Project

Ae¹,

Sidney²,

Ek³

et al. 2018

J Midwife Womens Health

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IntroductionIn 2014, Ontario opened 2 stand‐alone midwifery‐led birth centers. Using mixed methods, we evaluated the first year of operations for quality and safety, client experience, and integration into the maternity care community. This article reports on our study of safety and quality of care.MethodsThis descriptive evaluation focused on women admitted to a birth center at the beginning of labor. For context, we matched this cohort (on a 1:4 basis) with similar low‐risk midwifery clients giving birth in a hospital. Data sources included Ontario's Better Outcomes Registry and Network (BORN) Information System, the Canadian Institute for Health Information, Ontario census data, and birth center records.ResultsOf 495 women admitted to a birth center, 87.9% experienced a spontaneous vaginal birth, regardless of the eventual location of birth, and 7.7% had a cesarean birth. The transport rate to a hospital was 26.3%. When compared with midwifery clients with a planned hospital birth, rates of intervention (epidural analgesia, labor augmentation, assisted vaginal birth, and cesarean birth) were significantly lower in the planned birth center group, even when controlled for previous cesarean birth and body mass index. Markers of potential morbidity were identified in about 10% of birth center births; however, there were no short‐term health impacts up to discharge from midwifery care at 6 weeks postpartum. Care was low in intervention and safe (minimal negative outcomes and transport rates comparable to the literature).DiscussionIn the first year of operation, care was consistent with national guidelines, and morbidity and mortality rates and intervention rates were low for women with low‐risk pregnancies seeking a low‐intervention approach for labor and birth. Further evaluation to confirm these findings is required as the number of births grows.

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Section: Discussionsupporting

confidence: 76%

Section: Discussionmentioning

confidence: 79%

Section: Discussionmentioning

confidence: 96%

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Outcomes for the First Year of Ontario's Birth Center Demonstration Project

Ae¹,

Sidney²,

Ek³

et al. 2018

J Midwife Womens Health

View full text Add to dashboard Cite

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“…Additionally, international studies showed a significantly lower risk of episiotomy [12, 13], pharmacological pain management [12–15], assisted vaginal birth [12, 13], caesarean section [12, 13], and augmentation of labour [12–15] in birth settings other than obstetric units, although in one study no difference in rate of instrumental births was found [15]. …”

Section: Introductionmentioning

confidence: 99%

“…However, these studies have been conducted in countries with relatively low home birth rates, not exceeding 7% [12, 13, 15]. In the Netherlands, home birth has traditionally been part of the established maternity care system.…”

Section: Introductionmentioning

confidence: 99%

Effect of planned place of birth on obstetric interventions and maternal outcomes among low-risk women: a cohort study in the Netherlands

Bolten

Jonge

Zwagerman

et al. 2016

BMC Pregnancy Childbirth

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BackgroundThe use of interventions in childbirth has increased the past decades. There is concern that some women might receive more interventions than they really need. For low-risk women, midwife-led birth settings may be of importance as a counterbalance towards the increasing rate of interventions. The effect of planned place of birth on interventions in the Netherlands is not yet clear. This study aims to give insight into differences in obstetric interventions and maternal outcomes for planned home versus planned hospital birth among women in midwife-led care.MethodsWomen from twenty practices across the Netherlands were included in 2009 and 2010. Of these, 3495 were low-risk and in midwife-led care at the onset of labour. Information about planned place of birth and outcomes, including instrumental birth (caesarean section, vacuum or forceps birth), labour augmentation, episiotomy, oxytocin in third stage, postpartum haemorrhage >1000 ml and perineal damage, came from the national midwife-led care perinatal database, and a postpartum questionnaire.ResultsWomen who planned home birth more often had spontaneous birth (nulliparous women aOR 1.38, 95 % CI 1.08–1.76, parous women aOR 2.29, 95 % CI 1.21–4.36) and less often episiotomy (nulliparous women aOR 0.73, 0.58–0.91, parous women aOR 0.47, 0.33–0.68) and use of oxytocin in the third stage (nulliparous women aOR 0.58, 0.42–0.80, parous women aOR 0.47, 0.37–0.60) compared to women who planned hospital birth. Nulliparous women more often had anal sphincter damage (aOR 1.75, 1.01–3.03), but the difference was not statistically significant if women who had caesarean sections were excluded. Parous women less often had labour augmentation (aOR 0.55, 0.36–0.82) and more often an intact perineum (aOR 1.65, 1.34–2.03). There were no differences in rates of vacuum/forceps birth, unplanned caesarean section and postpartum haemorrhage >1000 ml.ConclusionsWomen who planned home birth were more likely to give birth spontaneously and had fewer medical interventions.

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Postpartum Emergency Department Use Following Midwifery-Model vs Obstetrics-Model Care

Sorbara,

Ray,

Darling

et al. 2024

JAMA Netw Open

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ImportanceEmergency department (ED) use postpartum is a common and often-preventable event. Unlike traditional obstetrics models, the Ontario midwifery model offers early care postpartum.ObjectiveTo assess whether postpartum ED use differs between women who received perinatal care in midwifery-model care vs in traditional obstetrics-model care.Design, Setting, and ParticipantsThis retrospective population-based cohort study took place in Ontario, Canada, where public health care is universally funded. Participants included women who were low risk and primiparous and gave birth to a live baby in an Ontario hospital between 2012 and 2018. Data were collected from April 2012 to March 2018 and analyzed from June 2022 to April 2023.ExposuresPerinatal care clinician, namely, a midwife or obstetrician.Main Outcome and Measures: Any unscheduled ED visit 42 days postpartum or less. Poisson regression models compared ED use between women with midwifery-model care vs obstetrics-model care, weighting by propensity score-based overlap weights.ResultsAmong 104 995 primiparous women aged 11 to 50 years, those in midwifery-model care received a median (IQR) of 7 (6-8) postpartum visits, compared with 0 (0-1) visits among those receiving obstetrics-model care. Unscheduled ED visits 42 days or less postpartum occurred for 1549 of 23 124 women (6.7%) with midwifery-model care compared with 6902 of 81 871 women (8.4%) with traditional obstetrics-model care (adjusted relative risks [aRR], 0.78; 95% CI, 0.73-0.83). Similar aRRs were seen in women with a spontaneous vaginal birth (aRR, 0.71; 95% CI, 0.65-0.78) or assisted vaginal birth (aRR, 0.70; 95% CI, 0.59-0.82) but not those with a cesarean birth (aRR, 0.94; 95% CI, 0.86-1.03) or those with intrapartum transfer of care between a midwife and obstetrician (aRR, 0.94; 95% CI, 0.87-1.04). ED use 7 days or less postpartum was also lower among women receiving midwifery model care (aRR, 0.70; 95% CI, 0.65-0.77).Conclusions and RelevanceIn this cohort study, midwifery-model care was associated with less postpartum ED use than traditional obstetrics-model care among women who had low risk and were primiparous, which may be due to early access to postpartum care provided by Ontario midwives.

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Outcomes associated with planned place of birth among women with low-risk pregnancies

Cited by 86 publications

References 7 publications

Outcomes for the First Year of Ontario's Birth Center Demonstration Project

Outcomes for the First Year of Ontario's Birth Center Demonstration Project

Effect of planned place of birth on obstetric interventions and maternal outcomes among low-risk women: a cohort study in the Netherlands

Postpartum Emergency Department Use Following Midwifery-Model vs Obstetrics-Model Care

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