A risk model to predict probability of maternal intrapartum transfers from a free‐standing birth centre: PROTRIP tool

Abstract

Birth care in out-of-hospital clinical settings, including alongside and free-standing midwifery-led birth centres, is a controversial topic internationally, especially with respect to issues of safety. A number of studies conducted in different country settings have found that maternal and neonatal outcomes following birth to low-risk women in out-of-hospital settings led by midwives are generally favourable when compared to results obtained from obstetric-led units (Birthplace in England Collaborative Group 2011). Notwithstanding, women who chose to give birth at these facilities and who need to be transferred to the obstetric unit represent a potential at-risk group in a population of low-risk women. Intrapartum transfers from midwifery-led birth centres have been associated with higher rates of Caesarean sections, operative vaginal births, episiotomy, lower infant Apgar scores at five minutes, higher number of infants with arterial cord blood pH values <7 10 and a higher number of infants admitted to neonatal intensive care unit (NICU) (David et al. 2006, Overgaard et al. 2011). Few studies have investigated the outcomes of maternal transfers from birth centres, and no risk models have been identified in this area of health care. This is despite risk models being increasingly used in other areas of health, as care becomes more tailored to individual characteristics and needs. There is potential for an evaluation tool to be used when the woman arrives at the birth centre, as it will be based on her clinical presentation on admission, her pregnancy and previous medical history.