Service configuration, unit characteristics and variation in intervention rates in a national sample of obstetric units in England: an exploratory analysis

Abstract

ObjectivesTo explore whether service configuration and obstetric unit (OU) characteristics explain variation in OU intervention rates in ‘low-risk’ women.DesignEcological study using funnel plots to explore unit-level variations in adjusted intervention rates and simple linear regression, stratified by parity, to investigate possible associations between unit characteristics/configuration and adjusted intervention rates in planned OU births. Characteristics considered: OU size, presence of an alongside midwifery unit (AMU), proportion of births in the National Health Service (NHS) trust planned in midwifery units or at home and midwifery ‘under’ staffing.Setting36 OUs in England.Participants‘Low-risk’ women with a ‘term’ pregnancy planning vaginal birth in a stratified, random sample of 36 OUs.Main outcome measuresAdjusted rates of intrapartum caesarean section, instrumental delivery and two composite measures capturing birth without intervention (‘straightforward’ and ‘normal’ birth).ResultsFunnel plots showed unexplained variation in adjusted intervention rates. In NHS trusts where proportionately more non-OU births were planned, adjusted intrapartum caesarean section rates in the planned OU births were significantly higher (nulliparous: R2=31.8%, coefficient=0.31, p=0.02; multiparous: R2=43.2%, coefficient=0.23, p=0.01), and for multiparous women, rates of ‘straightforward’ (R2=26.3%, coefficient=−0.22, p=0.01) and ‘normal’ birth (R2=17.5%, coefficient=0.24, p=0.01) were lower. The size of the OU (number of births), midwifery ‘under’ staffing levels (the proportion of shifts where there were more women than midwives) and the presence of an AMU were associated with significant variation in some interventions.ConclusionsTrusts with greater provision of non-OU intrapartum care may have higher intervention rates in planned ‘low-risk’ OU births, but at a trust level this is likely to be more than offset by lower intervention rates in planned non-OU births. Further research using high quality data on unit characteristics and outcomes in a larger sample of OUs and trusts is required.

Nutri-Epigenetics and Gut Microbiota: How Birth Care, Bonding and Breastfeeding Can Influence and Be Influenced?

“…Birth in hospital with a concurrent increase in the medicalization of the birth process has resulted in an overuse of intrapartum interventions and a global rise in CS as “mode of birth” [ 117 ]. Therefore, place of birth may be a factor that is associated with maternal wellbeing and birth outcomes [ 118 ]. Healthy women who have the opportunity to birth in settings/facilities that offer sufficient space to stand/move around, have access to birth companions and the support of a midwife on a one-to-one basis, are associated with improved outcomes and fewer interventions [ 119 ].…”

Mode of birth and medical interventions among women at low risk of complications: A cross-national comparison of birth settings in England and the Netherlands

“…An exploratory analysis in England found that intervention rates were higher in planned obstetric unit births compared to births in midwife-led settings in areas where higher proportions of women planned birth in midwife-led settings. [ 27 ]…”

Transfers of Care between Healthcare Professionals in Obstetric Units of Different Sizes across Spain and in a Hospital in Ireland: The MidconBirth Study

“…All the public maternity units are technically orientated and able to attend both high risk and low-risk births. This raises issues as to the dubious benefits of giving birth in mixed environments, as recent studies have shown positive health results when healthy women are treated in midwife-led units that are separated from conventional obstetric units [ 6 , 37 ].…”