The National Birth Center Study Part II—Intrapartum and immediate postpartum and neonatal care

Rooks, Judith P.; Weatherby, Norman L.; Ernst, Eunice K.M.

doi:10.1016/0091-2182(92)90239-y

Cited by 53 publications

(59 citation statements)

References 63 publications

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“…The study findings also agree with other studies of FMU care6 10 18 24 26 28 29 that have all reported a reduced incidence of birth interventions while the caesarean section rate is seldom found to be affected, something which may stem from inadequacies in the power or robustness of their design. In this respect, our study forms an important exception in finding a significant reduction in caesarean section in women in the FMU group.…”

Section: Discussionsupporting

confidence: 90%

“…The overall rate of transfers intrapartum and <2 h after birth at 14.8% is comparable18 or slightly lower than that found in some studies of FMU care21 22 24 26 (18–24%), though one study6 reported a slightly lower rate of 12%. Few studies report transfer rates for primiparas and multiparas separately, but a large American study also finds a transfer rate of 7% for multiparas but a lower rate of 29% for primiparas 24.…”

Section: Discussionmentioning

confidence: 53%

“…Few studies report transfer rates for primiparas and multiparas separately, but a large American study also finds a transfer rate of 7% for multiparas but a lower rate of 29% for primiparas 24. In all studies, slow progress of labour was one of the most common reasons for transfer, depending on the strictness of transfer guidelines.…”

Section: Discussionmentioning

confidence: 99%

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Freestanding midwifery unit versus obstetric unit: a matched cohort study of outcomes in low-risk women

et al. 2011

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ObjectiveTo compare perinatal and maternal morbidity and birth interventions in low-risk women giving birth in two freestanding midwifery units (FMUs) and two obstetric units (OUs).DesignA cohort study with a matched control group.SettingThe region of North Jutland, Denmark.Participants839 low-risk women intending FMU birth and a matched control group of 839 low-risk women intending OU birth were included at the start of care in labour. OU women were individually chosen to match selected obstetric/socio-economic characteristics of FMU women. Analysis was by intention to treat.Main outcome measuresPerinatal and maternal morbidity and interventions.ResultsNo significant differences in perinatal morbidity were observed between groups (Apgar scores <7/5, <9/5 or <7/1, admittance to neonatal unit, asphyxia or readmission). Adverse outcomes were rare and occurred in both groups. FMU women were significantly less likely to experience an abnormal fetal heart rate (RR: 0.3, 95% CI 0.2 to 0.5), fetal–pelvic complications (0.2, 0.05 to 0.6), shoulder dystocia (0.3, 0.1 to 0.9), occipital–posterior presentation (0.5, 0.3 to 0.9) and postpartum haemorrhage >500 ml (0.4, 0.3 to 0.6) compared with OU women. Significant reductions were found for the FMU group's use of caesarean section (0.6, 0.3 to 0.9), instrumental delivery (0.4, 0.3 to 0.6), and oxytocin augmentation (0.5, 0.3 to 0.6) and epidural analgesia (0.4, 0.3 to 0.6). Transfer during or <2 h after birth occurred in 14.8% of all FMU births but more frequently in primiparas than in multiparas (36.7% vs 7.2%).ConclusionComparing FMU and OU groups, there was no increase in perinatal morbidity, but there were significantly reduced incidences of maternal morbidity, birth interventions including caesarean section, and increased likelihood of spontaneous vaginal birth. FMU care may be considered as an adequate alternative to OU care for low-risk women. Pregnant prospective mothers should be given an informed choice of place of birth, including information on transfer.

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Section: Discussionsupporting

confidence: 90%

Section: Discussionmentioning

confidence: 53%

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Freestanding midwifery unit versus obstetric unit: a matched cohort study of outcomes in low-risk women

et al. 2011

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“…Safety concerns have been expressed, especially over the considerably higher transfer rates from FMUs to specialised obstetric units for primiparous women [36, 37, 45, 46]. One study in particular reported a higher incidence of urgent transfers among primiparas [36].…”

Section: Introductionmentioning

confidence: 99%

Are freestanding midwifery units a safe alternative to obstetric units for low-risk, primiparous childbirth? An analysis of effect differences by parity in a matched cohort study

Christensen

Overgaard

2017

BMC Pregnancy Childbirth

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BackgroundIntrapartum complications and the use of obstetric interventions are more common in primiparous childbirth than in multiparous childbirth, leading to concern about out of hospital birth for primiparous women. The purpose of this study was to determine whether the effect of birthplace on perinatal and maternal morbidity and the use of obstetric interventions differed by parity among low-risk women intending to give birth in a freestanding midwifery unit or in an obstetric unit in the North Denmark Region.MethodsThe study is a secondary analysis of data from a matched cohort study including 839 low-risk women intending birth in a freestanding midwifery unit (primary participants) and 839 low-risk women intending birth in an obstetric unit (individually matched control group). Analysis was by intention-to-treat. Conditional logistic regression analysis was applied to compute odds ratios and effect ratios with 95% confidence intervals for matched pairs stratified by parity.ResultsOn no outcome did the effect of birthplace differ significantly between primiparous and multiparous women. Compared with their counterparts intending birth in an obstetric unit, both primiparous and multiparous women intending birth in a freestanding midwifery unit were significantly more likely to have an uncomplicated, spontaneous birth with good outcomes for mother and infant and less likely to require caesarean section, instrumental delivery, augmented labour or epidural analgesia (although for caesarean section this trend did not attain statistical significance for multiparous women). Perinatal outcomes were comparable between the two birth settings irrespective of parity. Compared to multiparas, transfer rates were substantially higher for primiparas, but fell over time while rates for multiparas remained stable.ConclusionsFreestanding midwifery units appear to confer significant advantages over obstetric units to both primiparous and multiparous mothers, while their infants are equally safe in both settings. Our findings thus support the provision of care in freestanding midwifery units as an alternative to care in obstetric units for all low-risk women regardless of parity. In view of the global rise in caesarean section rates, we consider it an important finding that freestanding midwifery units show potential for reducing first-birth caesarean.Electronic supplementary materialThe online version of this article (doi:10.1186/s12884-016-1208-1) contains supplementary material, which is available to authorized users.

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“…• The National Birth Center Study (Rooks, 1992a(Rooks, , 1992b evaluated the care and outcomes of 11,814 women admitted in labor at 84 birth centers and found the following practice patterns:…”

Section: Purposementioning

confidence: 99%

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The National Birth Center Study Part II—Intrapartum and immediate postpartum and neonatal care

Cited by 53 publications

References 63 publications

Freestanding midwifery unit versus obstetric unit: a matched cohort study of outcomes in low-risk women

Freestanding midwifery unit versus obstetric unit: a matched cohort study of outcomes in low-risk women

Are freestanding midwifery units a safe alternative to obstetric units for low-risk, primiparous childbirth? An analysis of effect differences by parity in a matched cohort study

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