Well women birth better in primary level care, study says

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08 Sep 2017

Primary-level maternity units (PMUs) offer birthing facilities with midwifery services, while tertiary and secondary-level units offer midwifery services, specialist obstetric, anaesthetic and paediatric services.

The results of the study supported midwife-led, primary-level maternity units as physically safe places for well women to plan to give birth. These women had higher rates of natural birthing than those low risk pregnancy women who planned a tertiary hospital birth, and lower interventions.  

Ara midwifery academics Rea Daellenbach and Mary Kensington were part of the Trans-Tasman research team for the study and resulting paper: Evaluating Maternity Units: a prospective cohort study of freestanding midwife-led primary maternity units in New Zealand—clinical outcomes.

The study was led by Christchurch midwife Celia Grigg and included three researchers from different universities in Sydney, Australia.

“Many people believe birth is only normal in retrospect and that women should have their babies in an obstetric led hospital. However, this research complements other research on place of birth which shows that women who are low risk are better off utilising a midwife led primary birth facility,’ Mary Kensington said.

This study examined outcomes for women who planned to give birth in the immediate Christchurch area, in either Christchurch Women’s Hospital or in one of the primary units. The data was analysed by where women had planned to birth. Some women who planned to birth at a primary unit actually had their babies in the hospital. However, overall the women who initially planned to go to a primary unit still had better outcomes than the low risk women who had planned a hospital birth.

“The results can give women with low risk pregnancies confidence in planning to give birth in a midwife-led primary birthing unit and in the New Zealand maternity system,” Rea Daellenbach said.

The study was conducted in Christchurch because of the high number of primary-level maternity units. New Zealand has 54 freestanding midwife-led Primary Maternity Units (PMUs) altogether. The country has 18 secondary-level and six tertiary-level obstetric-led maternity hospitals or Tertiary Medical Units (TMHs), with specialist services.

Most women still chose to birth in hospital. In 2015, 86.4% of New Zealand births occurred in a secondary or tertiary hospital, 9.9% in a freestanding PMU and 3.4% were home births.

The study is the first of its kind in New Zealand to follow women from their planned place of pregnancy through to outcomes, rather than commencing from the women’s labour. The researchers acknowledged that the Christchurch earthquakes may have impacted on the study.

A larger nationwide study using this design would be valuable to provide stronger evidence for these results, the researchers said.