Abstract
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.
Highlights
Intrapartum 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
In the Danish birth centre study of care in Freestanding midwifery unit (FMU) versus Obstetric unit (OU), we have previously found that low-risk women intending birth in an FMU had significantly lower morbidity and were significantly less likely to require obstetric intervention compared with low-risk women intending birth in an OU
Our aim was to determine whether the effect of birthplace on perinatal and maternal morbidity, birth interventions, use of pain relief and birth positions differed by parity among low-risk women intending to give birth in an OU or FMU in the North Denmark Region
Summary
Intrapartum 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. Several newer observational studies provide evidence that the greatest contributor to this development is a sharp increase in caesarean delivery among low-risk primiparous women, leading to a subsequent increase in repeat caesarean sections [19,20,21,22,23,24,25,26,27]. This trend should be seen in light of the progressive increase in hospitalised childbirths witnessed in most high- and middle-income countries over the last century. Hospitalisation and the centralisation of childbirth, have coincided with a steady increase in obstetric intervention rates that have far exceeded clinically indicated levels [28,29,30], suggesting that OUs may not always provide an optimal setting for uncomplicated deliveries
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