Perinatal and maternal outcomes at term in low-risk pregnancies according to NICE criteria: comparison between a tertiary obstetrical hospital and midwife-attended units

PURPOSE

The aim of this study was to evaluate the perinatal and maternal outcomes at term at a single tertiary, university hospital in women with low-risk pregnancies.

PATIENTS AND METHODS

We performed a retrospective cohort study of women with low-risk pregnancies, who delivered at University Women's Hospital Magdeburg between January 2010 and December 2014. Data were compared with data published by Brocklehurst et al. 2011.

RESULTS

Of the 6052 women investigated, 2014 were classified as low risk according to the NICE criteria and were eligible for analysis. In 94.8%, a spontaneous vertex birth was observed. There were only 2 (0.1%) perinatal complications and 52 (2.5%) maternal complications. Ventouse delivery, forceps delivery, and caesarean sections were performed in 2.5, 1, and 3.1% of the cases, respectively. Episiotomy was performed in 37.7% of women. The third and fourth degree perineal trauma were observed in 0.3% of births investigated. Complications during the third stage of labour and blood transfusions were observed in 0.25 and 0.2%, respectively. In comparison with the births at home, we had lower rate of fetal complications for nulliparous women, but not for multiparous women, lower rate for blood transfusions, third and fourth degree perineal trauma and forceps delivery, and higher rate of spontaneous vertex birth, epidural analgesia, and episiotomy. The rate of vacuum extractions and caesarean sections were similar between both the places of birth.

CONCLUSIONS

The tertiary-level obstetric unit is safe place of birth for women with low-risk pregnancies.

Experiences of women who planned birth in a birth centre compared to alternative planned places of birth. Results of the Dutch Birth Centre Study

OBJECTIVE

to assess the experiences with maternity care of women who planned birth in a birth centre and to compare them to alternative planned places of birth, by using the responsiveness concept of the World Health Organization.

DESIGN

this study is a cross-sectional study using the ReproQ questionnaire filled out eight to ten weeks after birth. The primary outcome was responsiveness of birth care. Secondary outcomes included overall grades for birth care and experiences with the birth centre services. Regression analyses were performed to compare experiences among the planned places of birth. The study is part of the Dutch Birth Centre Study.

SETTING

the women were recruited by 82 midwifery practices in the Netherlands, within the study period 1 August 2013 and 31 December 2013.

PARTICIPANTS

a total of 2162 women gave written consent to receive the questionnaire and 1181 (54.6%) women completed the questionnaire.

MEASUREMENTS AND FINDINGS

women who planned to give birth at a birth centre: (1) had similar experiences as the women who planned to give birth in a hospital receiving care of a community midwife. (2) had significantly less favourable experiences than the women who planned to give birth at home. Differences during birth were seen on the domains dignity (OR=1.58, 95% CI=1.09-2.27) and autonomy (OR=1.77, 95% CI=1.25-2.51), during the postpartum period on the domains social considerations (OR=1.54, 95% CI=1.06-2.25) and choice and continuity (OR=1.43, 95% CI=1.00-2.03). (3) had significantly better experiences than the women who planned to give birth in a hospital under supervision of an obstetrician. Differences during birth were seen on the domains dignity (OR=0.51, 95% CI=0.31-0.81), autonomy (OR=0.59, 95% CI=0.35-1.00), confidentiality (OR=0.57, 95% CI=0.36-0.92) and social considerations (OR=0.47, 95% CI=0.28-0.79). During the postpartum period differences were seen on the domains dignity (OR=0.61, 95% CI=0.38-0.98), autonomy (OR=0.52, 95% CI=0.31-0.85) and basic amenities (OR=0.52, 95% CI=0.30-0.88). More than 80% of the women who received care in a birth centre rated the facilities, the moment of arrival/departure and the continuity in the birth centre as good.

KEY CONCLUSIONS AND IMPLICATIONS FOR PRACTICE

in the last decades, many birth centres have been established in different countries, including the United Kingdom, Australia, Sweden and the Netherlands. For women who do not want to give birth at home a birth centre is a good choice: it leads to similar experiences as a planned hospital birth. Emphasis should be placed on ways to improve autonomy and prompt attention for women who plan to give birth in a birth centre as well as on the improvement of care in case of a referral.

Unique and proforma birth plans: a qualitative exploration of midwives׳ experiences

BACKGROUND

birth plans detailing a woman׳s preferences for intrapartum care are a common feature in British maternity units, and are a means of encouraging the implementation of choice. Proforma versions may be incorporated routinely in antenatal case notes, or the woman may devise her own unique birth plan. Although women׳s views of birth plans have been explored, the views of midwives have not to date been evaluated. The growth of midwife-led units in the UK has highlighted different philosophies of care, some of which can be reflected in the different types of birth plan. Given the increasingly diverse nature of UK midwifery workplaces we set out to explore and compare the experience of midwives working in midwife-led and obstetric-led settings in relation to unique and proforma birth plans.

METHOD

qualitative study using focus groups of midwives in a midwife-led unit (MLU; n=5) and obstetric-led unit (OLU; n=4) in the East of England. We used an interpretative phenomenological analytical approach.

FINDINGS

three main themes arose from the data. Firstly, the term 'birth plan' can be misleading, and was criticised for encouraging the belief that birth can be 'planned'. In addition, midwives claimed that 'unique' birth plans, especially those influenced by some consumer advocacy groups, are becoming standardised in their rejection of policies and procedures and requests for intervention-free birth. Secondly, birth plans were a source of irritation for midwives in both groups, although the cause of the irritation differed between groups. Finally, it was found that midwives in both groups felt that birth plans put pressure on them, although again, the source of the pressure, and therefore the way in which midwives reacted to this pressure, differed between groups.

CONCLUSIONS

the term 'birth plan' can be misleading and create false expectations. If 'unique' birth plans are becoming 'standardised' in the sense that they routinely request the same things, they are little different to proforma birth plans. Some midwives perceive pressure both from women and the wider multidisciplinary team as a result of birth plans, a perception that causes some irritation.