The National Birth Center Study Part III—Intrapartum and immediate postpartum and neonatal complications and transfers, postpartum and neonatal care, outcomes, and client satisfaction

Factors associated with maternal intrapartum transfers from a freestanding birth centre in São Paulo, Brazil: A case control study

“…The intrapartum transfer rate from the birth centres was 11.5%, but primiparous women were transferred in greater numbers (36.7%) compared to multiparous women (7.2%) (Overgaard et al, 2011). An American study which included 84 BCs reported an intrapartum transfer rate four times higher among nulliparous compared with multiparous women (Rooks et al, 1992). The location of these facilities was not stated.…”

“…Clinical decision making is complex and may have to take account of a number of complications, such as the presence of meconium stained amniotic fluid, abnormalities in the fetal heart rate and phase of the labour (Rooks et al, 1992). To be aware of potential factors associated with transfer prior to labour may assist clinical decision making about need for intrapartum transfer, as well as support evidence based information provision when discussing the most appropriate place to give birth with a woman and her family.…”

Midwifery care, social and medical risk factors, and birth outcomes in the USA

“…16 26-28 The exclusion of caesarean births from the sample also helps to reduce potential bias, because a high proportion of patients transferred from midwifery to physician care undergo caesarean section. 28 Although steps were taken where possible to minimise potential bias, some degree of bias may still be present, and may in part account for the diVerences in birth outcomes found in this study. It is reassuring to note, however, that many of the hospital or clinic-based studies in the literature were able to attribute outcomes for transferred patients to the attendant who provided the prenatal care, and still reported birth outcomes for certified nurse midwives that were as good as or better than those for physicians.…”

The evidence for emergency obstetric care

“…The vast majority of maternal deaths are due to direct obstetric complications—hemorrhage, sepsis, complications of abortion, hypertensive disorders of pregnancy, prolonged/obstructed labor, ruptured uterus and ectopic pregnancy [2]. These complications occur even in well‐nourished, well‐educated women [3] receiving adequate prenatal and delivery care [4] and generally cannot be predicted [5–9]. While some strides have been made in the prevention of some of the direct obstetric complications, many cannot be prevented even in the best of circumstances.…”