Birth centre confinement at the Queen Victoria Medical Centre: four years' experience

Obstetric risks and outcomes: birth centre compared with conventional labour ward

Birth centres in Australia provide an option for women and their professional advisors when choosing the setting for childbirth. It is important that empirical information about the risks is available to enable informed decisions to be made. The purpose of this study was to compare the obstetric outcomes for women admitted to the Birth Centre at Royal Hospital for Women in Sydney with outcomes for women admitted to the conventional labour ward, controlling for prenatal and intrapartum risk. The findings indicate that, with the existing back-up provided by the conventional service, the outcomes for women admitted to the Birth Centre were at least as good as those of the other women. The study also shows that there are differences between the two settings in the management of the intrapartum period. The rate of intervention is substantially higher for women admitted to the Labour Ward, after risk is taken into consideration. The evaluation indicates that the Birth Centre offers a viable choice for women with relatively low obstetric risk.

Quel risque néonatal pour les grossesses à bas risque: implications pédiatriques pour l'organisation des maisons de naissance?

AIM

This study was designed to identify pregnant women at low risk for severe neonatal morbidity. This population should apply for delivery in birth centers.

POPULATION AND METHODS

This study was retrospective and included all livebirths in Burgundy over a 4-year period. Fifteen obstetric criteria recorded in the regional perinatal database were used to select pregnant women at low risk for severe neonatal morbidity. Incidence of severe neonatal morbidity in the low and high risk groups was assessed from the following markers: postnatal death; severe neurological conditions (ischemic encephalopathy, seizures, meningitis, intraventricular hemorrhage stage 3-4 and cystic periventricular leukomalacia in preterm infants); tracheal intubation; hospitalization in neonatal intensive care unit.

RESULTS

The incidence of severe neonatal morbidity was significantly different (P<0.0001) in the low risk group (0.34% [IC 95%: 0.29-0.40]; N=46345) as compared with the high risk group (5.6% [IC 95%: 5.3-5.9]; N=24961). The main neonatal diseases in the low risk group were: respiratory diseases (29.8%); congenital heart diseases (17.9%) and perinatal asphyxia (15.3%).

CONCLUSION

Even though the low risk criteria were associated with a low incidence of severe neonatal morbidity, residual morbidity should be considered in organization of birth centers in France.

Normality and collaboration: mothers' perceptions of birth centre versus hospital care

OBJECTIVE

to describe women's perceptions of care in Western Australian birth centres following a previous hospital birth.

DESIGN, SETTING AND PARTICIPANTS

an exploratory design was used to study the care experiences of 17 women recruited from three Western Australian birth centres. Data were obtained from in-depth interviews that explored women's perceptions of their care in both the birth centre and hospital context.

FINDINGS

four key themes emerged from the analysis: 'beliefs about pregnancy and birth', 'nature of the care relationship', 'care interactions', and 'care structures'. The themes of 'beliefs about pregnancy and birth' and 'nature of the care relationship' are discussed in this paper. Beliefs about pregnancy and birth refer to the philosophical underpinnings of pregnancy and birth held by women and their carers. Nature of the care relationship identifies women's perceptions of their relationship with health professionals. Care interactions and care structures will be described in a subsequent paper.

KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE

The women's comments suggested differences in philosophy between hospital and birth-centre settings. The philosophy and beliefs of caregivers was an important component of the care experience. Women valued the normality of the birth-centre approach and the opportunity to experience the birth of their child with collaborative support from a midwife.

Midwife-led maternity services and consumer 'choice' in an Australian metropolitan region

OBJECTIVE

Identify the factors determining women's support for midwife-led maternity care in an Australian metropolitan region, and identify the implications for the role of midwives and for the expansion of options for childbearing women.

DESIGN

A two-stage research design was utilised. In the first stage a sample of women were surveyed regarding their choice of maternity service provider and site of provision of maternity services. In the second stage, in-depth interviews were used to collect the birthing narratives of a sample of 50 women involved in the first stage of the research.

SETTING

A metropolitan region of Adelaide, South Australia.

PARTICIPANTS

Women who had given birth to a live baby in the 1991 calendar year, who lived within a designated region and who gave birth at one of four hospitals in or near the region. In the first stage of the study, 519 women returned surveys, giving a response rate of 61.7%. Sixty-four per cent of these women expressed an interest in being involved in further research, and fifty of these were randomly selected for interview.

FINDINGS

Despite recent calls in Australia to increase the choices available to childbearing women, these choices are limited by, amongst other things, insufficient information about midwife-led maternity services. The work of midwives remains silenced and invisible to many women pregnant for the first time, who have little idea about what midwives can do. This research shows that women's main source of information about midwife care is developed through the actual experience of it, particularly in giving birth. This experience leads to an extremely positive recognition and appraisal of the work of midwives, such that the majority of women indicate that they would be happy with midwife care for subsequent births. First-time mothers are significantly disadvantaged in terms of choices available to them because of this lack of information about midwife-led maternity care.

IMPLICATIONS

In the interests of providing childbearing women with real choices for maternity care, strategic interventions to better publicise the role of midwives and of midwife-led services are needed.

A randomised controlled trial comparing birthing centre care with delivery suite care in Adelaide, Australia

Birthing centre care offers women with a low risk of complication in pregnancy an alternative to conventional care for the birthing of their baby. It is important these two forms of care are appropriately assessed. A randomised controlled trial comparing the newly opened birthing centre with the established conventional delivery suite was conducted at the then Queen Victoria Hospital, Adelaide, South Australia. The outcomes measured included maternal satisfaction, costs and clinical outcomes both for mother and baby which related to the need for Caesarean section, episiotomy or tear rate and method of feeding. Two hundred and one women attending the hospital's antenatal clinic were randomly allocated to either birthing centre or delivery suite care. One hundred women were allocated to the birthing centre. No differences were found in either group related to clinical outcomes or costs. The only difference in maternal satisfaction was the choice women made for their next birth. More women in the birthing centre group felt they were encouraged to breastfeed immediately after birth. While the numbers in this study were too small to detect any but large differences in outcome, birthing centre care should remain an option for women and further studies undertaken with larger numbers.

A descriptive study of community input into the evolution of John Hunter Hospital Birth Centre: results of 'open entry' criteria

The key feature of John Hunter Hospital Birth Centre is that consumer input influences the philosophy and protocols of the unit through a management executive. The executive includes representatives from all groups who use the Birth Centre, including general practitioners, visiting midwives, obstetricians and staff midwives, as well as 50% consumer representation. This has resulted in a unique Birth Centre with open and flexible entry criteria. Since its opening in February 1991, 1,492 women have been admitted to John Hunter Hospital Birth Centre, and of these 1,221 (82%) gave birth there. This figure is greater than any other Birth Centre utilization rate in Australia (1-4). An examination of outcomes for 1992 indicates that neither the higher than usual utilization rate nor the open entry criteria has compromised safety for either women or their infants.

Women's satisfaction with birth center care: a randomized, controlled study

This randomized, controlled trial compared women's satisfaction with care at an in-hospital birth center with standard obstetric care in Stockholm. Subjects were 1230 women with an expected date of birth between October 1989 and February 1992, who expressed interest in birth center care, and who were medically low risk. The intervention was the random allocation of maternity care at the birth center or standard obstetric care. Birth center women expressed greater satisfaction with antenatal, intrapartum, and postpartum care, especially psychological aspects of care. Of these women, 63 percent thought that the antenatal care had raised their self-esteem, versus 18 percent of the control group. Eighty-nine percent of the experimental group would prefer birth center care for any future birth, and 46 percent of the control group would prefer standard care. Birth center care successfully meets the needs of women who are interested in natural childbirth and active involvement in their own care, and are concerned about the psychological aspects of birth.

The Royal Women's Hospital Family Birth Centre: the first 10 years reviewed

In reviewing the first 10 years experience of the Royal Women's Hospital Family Birth Centre (FBC), we examined the outcomes of pregnancy and labour in a group of women who requested alternative birthing care and who were identified antenatally as being a 'low-risk' population. This study is a retrospective analysis of 5,365 women booked with the birth centre between 1980 and 1989. Over 16% of women developed antenatal complications precluding further care there, while a further 16% developed complications in labour requiring transfer out to conventional labour wards. Thus 67% of those originally booked delivered in the FBC. The instrumental delivery rate was 11%, and the Caesarean section rate was 4%. Of the women who delivered in the FBC, 3.1% had a postpartum haemorrhage and 1.8% required manual removal of placenta. Approximately 4% of babies born in the FBC required some resuscitation, and 0.8% needed admission to the neonatal nursery. Two perinatal deaths occurred in women admitted in labour to the FBC with a live baby, whilst 2 other women presented in labour with a fetal death in utero (perinatal mortality 0.89 per 1,000).

The safety of team midwifery: the first decade of the Monash Birth Centre

OBJECTIVE

To review the safety of team midwifery care, in terms of perinatal mortality, for pregnant women assessed at their first visit as being at low risk of complications.

DESIGN

A cohort study.

SETTING

Team midwifery unit (Birth Centre) in a tertiary hospital.

PATIENTS

All women who made a booking and met the selection criteria at their first antenatal visit (3085), excluding those with spontaneous or induced fetal loss before 20 weeks (89) and those who withdrew at their own request to seek an alternative form of care (138); the 2858 remaining women gave birth to 2874 infants.

MAIN OUTCOME MEASURES

Perinatal mortality rate; and birthweight specific perinatal mortality ratio with reference values being specific rates for birthweight in Victoria for 1984-1985.

RESULTS

The perinatal mortality rate was 7.7 per 1000 births (95% confidence interval [CI] 4.8-11.6) for the whole cohort; for women beginning labour in the Birth Centre it was 1.3 per 1000 births (95% CI, 0.3-3.9). The birthweight standardised perinatal mortality ratio was 80 (95% CI, 50-122).

CONCLUSION

Within this setting, with explicit criteria for booking and referral, and a framework for consultation, team midwifery care is as safe as the standard maternity care provided within the State.