Exploration of preterm birth rates associated with different models of antenatal midwifery care in Scotland: Unmatched retrospective cohort analysis

Symon, Andrew; Winter, Clare; Cochrane, Lindy

doi:10.1016/j.midw.2015.02.012

Cited by 1 publication

(4 citation statements)

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“…This exceeded the rate derived from a national study of just over half (58.3%) of women who used a birthpool in labour [38]. Symon et al [4] noted the ‘eclectic’ nature of individual freestanding maternity units (or CMUs), where explanations for anomalies in the process and outcomes of care delivery in discrete local contexts require further exploration.…”

Section: Discussionmentioning

confidence: 90%

“…The Refreshed Framework for Maternity Care calls for the lead professional to be identified for all women by implementing national pathways and models of care. Symon et al [4], however, called into question the specificity of the risk assessment tools used to allocate care pathways for women in view of Cheyne et al’s [9] finding that 50% of women were at a high risk of obstetric complications at the end of pregnancy. Symon et al [4] made the assumption that half of the Freestanding Maternity Unit (FMU) cohort in their study did not give birth at the FMU as they were ineligible due to obstetric risk factors, however maternal choice in the absence of complications may also have been influential.…”

Section: Discussionmentioning

confidence: 99%

“…Symon et al [4], however, called into question the specificity of the risk assessment tools used to allocate care pathways for women in view of Cheyne et al’s [9] finding that 50% of women were at a high risk of obstetric complications at the end of pregnancy. Symon et al [4] made the assumption that half of the Freestanding Maternity Unit (FMU) cohort in their study did not give birth at the FMU as they were ineligible due to obstetric risk factors, however maternal choice in the absence of complications may also have been influential. In this CMU study, only 11.9% of the women changed their care pathway from midwife-led to obstetrician-led as antenatal obstetric complications or “risk factors” developed which may reveal that the detail in the data allows the differences between women’s clinical indications and individual preferences about place of birth to become clearer.…”

Section: Discussionmentioning

confidence: 99%

“…The guidance is based on primary evidence about safety that relates predominantly to births in urban settings in England. There appears to be little evidence available about the quality of the care during the entire childbirth continuum within the Scottish rural context [4]. …”

Section: Introductionmentioning

confidence: 99%

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Quality of care provided in two Scottish rural community maternity units: a retrospective case review

Denham

Humphrey

Taylor

2017

BMC Pregnancy Childbirth

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BackgroundWomen in Scotland with uncomplicated pregnancies are encouraged by professional bodies and national guidelines to access community based models of midwife-led care for their labour and birth. The evidence base for these guidelines relates to comparisons of predominantly urban birth settings in England. There appears to be little evidence available about the quality of the care during the antenatal, birth and post birth periods available for women within the Scottish Community Maternity Unit (CMU) model.The research aim was to explore the safety and effectiveness of the maternity services provided at two rural Community Maternity Units in Scotland, both 40 miles by main road access from a tertiary obstetric unit.MethodsFollowing appropriate NHS and University ethical approval, an anonymous retrospective review of consecutive maternity records for all women who accessed care at the CMUs over a 12 month period (June 2011 to May 2012) was undertaken in 2013 -14. Data was extracted using variables chosen to provide a description of the socio-demographics of the cohort and the process and outcomes of the care provided. Data were analysed using descriptive statistics.ResultsRegarding effectiveness, the correct care pathway was allocated to 97.5% of women, early access to antenatal care achieved by 95.7% of women, 94.8% of women at one CMU received continuity of carer and 78.6% of those clinically eligible accessed care in labour. 11.9% were appropriately transferred to obstetrician-led care antenatally and 16.9% were transferred in labour. All women received one-to one care in labour and 67.1% of babies born at the CMUs were breastfed at birth.Regarding safety, severe morbidity for women was rare, perineal trauma of 3rd degree tear occurred for 0.3% of women and 1.0% experienced an episiotomy. Severe post partum haemorrhage occurred for 0.3% of women. Babies admitted to the Neonatal unit were discharged within 48 hrs.ConclusionThese findings support the recommendations of professional bodies and national guidelines. Maternity service provision at rural CMUs achieved a consistently high standard of safety and effectiveness when measured against national standards and international evidence.

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Section: Discussionmentioning

confidence: 90%

Section: Discussionmentioning

confidence: 99%