Place of birth and outcomes for a cohort of low risk women in New Zealand: A comparison with Birthplace England

Abstract

rates of transfer from home (16.9%) or primary unit (12.6%) to hospital were lower than the Birthplace England cohort (21%). There was a higher proportion of nulliparous women (35%) in the planned homebirth group who transferred although this was significantly lower than the Birthplace England cohort (45%) (P<0.002). NZ Māori are the indigenous ethnicity of New Zealand, and a greater proportion of Māori planned birth in a primary unit (27.2%) than a secondary unit (23.2%), home (17.4%) or tertiary hospital (11.1%). The actual number of perinatal mortality outcomes was low across all settings for low risk women in New Zealand and differences in birthplace were not statistically significant (p < 0.14). Conclusion: A greater proportion of indigenous New Zealand women planned to birth at home or in a primary unit. Fewer women were transferred in labour in the NZ study. This research further refines our understanding of who plans to birth where, and reinforces the evidence that, where a low risk woman plans to birth in NZ, does not significantly increase adverse outcomes for her baby.

Factors associated with low Apgar in newborns in birth center

“…Prevalences of Apgar score < 7 in deliveries of low-risk women, for 2006-2010 in New Zealand, were higher than those found in our study: 1.5% for home delivery, 1.7% for extra-hospital NDC, 2.3% for care in secondary hospital, and 2.8% in tertiary hospital. There was a gradual increase in the prevalence of low Apgar proportional to the increase in the complexity of the care mode (21) . Davis et al (20) observed risk of Apgar score < 7 at the fifth minute in secondary and tertiary hospital 43% and 59% higher, respectively, than in delivery in primary care.…”

“…Recognizing that characteristics of extra-hospital and hospital modes may influence neonatal outcomes, some studies compare the results according to the specificity of the extra-hospital and hospital mode (20)(21) . Prevalences of Apgar score < 7 in deliveries of low-risk women, for 2006-2010 in New Zealand, were higher than those found in our study: 1.5% for home delivery, 1.7% for extra-hospital NDC, 2.3% for care in secondary hospital, and 2.8% in tertiary hospital.…”

Primary Maternity Units in rural and remote Australia: Results of a national survey

“…Such extensive suspensions fall short of the requirement for a service to operate at its given level at least 80% of the time (Commonwealth of Australia, 2012), effectively diminishing the number of PMUs maternity services functioning in rural Australia. The high levels of reliance on medical staff are also inconsistent with successful and sustainable models of care in similar facilities elsewhere (Brocklehurst et al, 2011;Dixon et al, 2012;Benatar et al, 2013;Dixon et al, 2014), some up to four hours flight from surgical services (van Wagner et al, 2012).…”

“…It is these shared characteristics that this study used to define Primary Maternity Units (PMUs). Published research demonstrates that PMUs, compared to secondary or tertiary maternity services, provide safe care in a range of locations with good clinical outcomes for women and infants including: no differences in perinatal mortality (Leeman and Leeman, 2002;Birthplace in England Collaborative Group, 2011;Monk et al, 2014); no differences or improved outcomes for perinatal morbidity (Leeman and Leeman, 2002;Birthplace in England Collaborative Group, 2011;Overgaard et al, 2011); improved outcomes for maternal morbidity (Overgaard et al, 2011); improved outcomes for birth interventions including fewer CS (Leeman and Leeman, 2002;Birthplace in England Collaborative Group, 2011;Davis et al, 2011;Overgaard et al, 2011;Tucker et al, 2013;Monk et al, 2014) and improved neonatal outcomes (Wax et al, 2010;Davis et al, 2011;Dixon et al, 2014;Monk et al, 2014).…”

Creating the first national linked dataset on perinatal and maternal outcomes in Australia: Methods and challenges

“…Similar large-scale studies examining outcomes by place of birth have been conducted in other high-income countries, including England [2], the Netherlands [3][4][5][6], Nordic countries [7,8], Canada [9][10][11][12], the United States [13][14][15] and New Zealand [16,17]. Although previous Australian research has investigated outcomes related to place of birth in single states [18][19][20], none has attempted to examine outcomes for women nation-wide.…”