Maternal and neonatal outcomes in birth centers versus hospitals among women with low‐risk pregnancies in Japan: A retrospective cohort study

Abstract

Aim: In order for low-risk pregnant women to base birth decisions on the risks and benefits, they need evidence of birth outcomes from birth centers. The purpose of this study was to describe and compare the maternal and neonatal outcomes of low-risk women who gave birth in birth centers and hospitals in Japan. Methods: The participants were 9588 women who had a singleton vaginal birth at 19 birth centers and two hospitals in Tokyo. The data were collected from their medical records, including their age, parity, mode of delivery, maternal position at delivery, duration of labor, intrapartum blood loss, perineal trauma, gestational weeks at birth, birth weight, Apgar score, and stillbirths. For the comparison of birth centers with hospitals, adjusted odds ratios for the birth outcomes were estimated by using a logistic regression analysis. Results: The number of women who had a total blood loss of >1 L was higher in the midwife-led birth centers than in the hospitals but the incidence of perineal lacerations was lower. There were fewer infants who were born at the midwife-led birth centers with Apgar scores of <7, compared to the hospitals. Conclusion: This study was the first to compare important maternal and neonatal outcomes of birth centers and hospitals. Additional research, using matched baseline characteristics, could clarify the comparisons for maternal and neonatal outcomes.

Investigating active versus expectant management of third stage labour in a midwife-led unit

“…Therefore, it can be inferred that expectant management did not lead to a higher rate of PPH. However, Kataoka et al (2018) found a significantly higher incidence of PPH (defined as blood loss of more than 1000 mL) in women, who birthed in midwife-led units, where women received expectant management, compared to the hospital obstetric-led units where women received active management. However, the generalisability of the findings of this study may be limited by the unknown effects of PPH risk factors on PPH incidence.…”

“…59 papers remained after screening the title and abstract. After reading the full text, nine papers (Begley et al, 2011;Davis et al, 2012;Dixon et al, 2009;2013;Fahy, et al, 2010;Grigg et al, 2017;Kataoka, et al, 2018;Laws, et al, 2014;Monk, et al, 2014) appeared to meet the inclusion criteria (see PRISMA diagram;…”

“…Kataoka et al (2018) conducted a study comparing numerous maternal and neonatal outcomes in midwife-led and hospital obstetric-led units in Japan, including PPH (defined as blood loss of more than 1000 mL) during the third stage of labour or shortly after birth. The study consisted of 9588 women at low risk of obstetric complications who had a spontaneous vaginal birth in one of 19 birth centres (midwife-led units), or in one of two hospital obstetric-led units.…”

Home birth integration into the health care systems of eleven international jurisdictions

“…Midwives can easily arrange ambulance transport for clients from planned home births to the hospital in British Columbia, England, Iceland, Japan, the Netherlands, New Zealand, Norway, Ontario, Sweden, and Washington State . There are home birth transport guidelines in British Columbia, Japan, New Zealand, Ontario, and Washington State .…”

A review of third stage of labour care guidance

“…Studies have shown that when women are offered expectant management as a reasonable option, they will choose it (Begley et al 2011a;Davies et al 2012, Dixon et al 20092013;Fahy et al 2010;Gottvall et al, 2011, Grigg et al 2017Kataoka et al 2018;Laws et al 2014;Monk et al 2014;Rogers et al 1998). Furthermore, the UK National Collaborating Centre for Women and Children's Health (2014) also acknowledges that some women may want to experience a birth with minimal intervention and request a physiological third stage of labour.…”