Abstract
BackgroundSocial inequity in perinatal and maternal health is a well-documented health problem even in countries with a high level of social equality. We aimed to study whether the effect of birthplace on perinatal and maternal morbidity, birth interventions and use of pain relief among low risk women intending to give birth in two freestanding midwifery units (FMU) versus two obstetric units in Denmark differed by level of social disadvantage.MethodsThe study was designed as a cohort study with a matched control group. It included 839 low-risk women intending to give birth in an FMU, who were prospectively and individually matched on nine selected obstetric/socio-economic factors to 839 low-risk women intending OU birth. Educational level was chosen as a proxy for social position. Analysis was by intention-to-treat.ResultsWomen intending to give birth in an FMU had a significantly higher likelihood of uncomplicated, spontaneous birth with good outcomes for mother and infant compared to women intending to give birth in an OU. The likelihood of intact perineum, use of upright position for birth and water birth was also higher. No difference was found in perinatal morbidity or third/fourth degree tears, while birth interventions including caesarean section and epidural analgesia were significantly less frequent among women intending to give birth in an FMU. In our sample of healthy low-risk women with spontaneous onset of labour at term after an uncomplicated pregnancy, the positive results of intending to give birth in an FMU as compared to an OU were found to hold for both women with post-secondary education and the potentially vulnerable group of FMU women without post-secondary education. In all cases, women without post-secondary education intending to give birth in an FMU had comparable and, in some respects, more favourable outcomes when compared to women with the same level of education intending to give birth in an OU. In this sample of low-risk women, we found that the effect of intended place on birth outcomes did not differ with women’s level of education.ConclusionFMU care appears to offer important benefits for birthing women with no additional risk to the infant. Both for women with and without post-secondary education, intending to give birth in an FMU significantly increased the likelihood of a spontaneous, uncomplicated birth with good outcomes for mother and infant compared to women intending to give birth in an OU. All women should be provided with adequate information about different care models and supported in making an informed decision about the place of birth.
Highlights
Social inequity in perinatal and maternal health is a well-documented health problem even in countries with a high level of social equality
We found no difference for perinatal outcomes while women in the freestanding midwifery units (FMU) group had reduced maternal morbidity and fewer birth interventions [59]
The aim was to study the whether the effect of intended birthplace on perinatal and maternal morbidity, birth interventions and use of pain relief and upright position for birth among low risk women intending to give birth in two FMU versus two Obstetric units (OU) in Denmark differed by level of social disadvantage
Summary
Social inequity in perinatal and maternal health is a well-documented health problem even in countries with a high level of social equality. The incidence of epidural analgesia [19,20], use of an upright birth position [21], caesarean section and other birth interventions have been suggested as being affected by social inequality, but results on caesarean section are conflicting with some studies finding a higher [22,23] and others a lower likelihood among disadvantaged women [24,25,26,27,28,29] It is unclear whether this inconsistency in findings for caesarean section and epidural is due to differences in the organisation of maternity care services (private/public) [25,28,29,30], hospital specialisation level [31], and the type of lead caregiver (obstetrician/midwife) [32]. Though, that the use of birth interventions is more widespread in societies with high levels of hospitalisation and specialisation and where private health services are prevalent [25,28,29,30,31]
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