Zusammenhänge zwischen Anwesenheit der Hebamme, Interventionen und dem Outcome der Geburt

Abstract

Continuity of midwifery care during labour is beneficial. We investigated the relationship between midwife presence, interventions and outcome. From the overall sample of singleton pregnancies in cephalic presentation (n=4 438) we selected 541 prospectively documented hospital-based birth processes occurring at term without antenatal risks and spontaneous mode of birth. Univariate and multivariate analyses were performed. Midwives were present for up to six hours in 66% of 247 births to primiparae, and for up to three hours in 61% of 294 births to multiparae. Midwives were present for more than 75% of the overall labour duration in 62% of all births in nulliparae and 63% in multiparae. Midwife presence for more than 75% of the total birth duration correlated positively to immersion in water (p<0.02), up to two CTG tracings (p<0.001), and up to three vaginal examinations (p<0.04). Midwives working in hospitals which contributed more than 50% of their eligible births were present for longer during labour than midwives in units with a lower participation rate (p<0.002). Multivariate regression revealed that up to two CTG tracings (p<0.001) and a participation rate of more than 50% (p<0.002) were significantly related to midwife presence. Intensive intrapartum midwife presence during spontaneous birth was associated neither with fetal outcome nor with interventions, except for up to two CTG tracings. This might be due to shorter labour or the later commencement of care. Intrapartum midwife presence covers a large portion of the birth process, but continues to be poorly understood.