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Freestanding midwifery unit versus obstetric unit: a matched cohort study of outcomes in low-risk women

OBJECTIVE: To compare perinatal and maternal morbidity and birth interventions in low-risk women giving birth in two freestanding midwifery units (FMUs) and two obstetric units (OUs). DESIGN: A cohort study with a matched control group. SETTING: The region of North Jutland, Denmark. PARTICIPANTS: 83...

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Autores principales: Overgaard, Charlotte, Møller, Anna Margrethe, Fenger-Grøn, Morten, Knudsen, Lisbeth B, Sandall, Jane
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BMJ Group 2011
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3191606/
https://www.ncbi.nlm.nih.gov/pubmed/22021892
http://dx.doi.org/10.1136/bmjopen-2011-000262
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author Overgaard, Charlotte
Møller, Anna Margrethe
Fenger-Grøn, Morten
Knudsen, Lisbeth B
Sandall, Jane
author_facet Overgaard, Charlotte
Møller, Anna Margrethe
Fenger-Grøn, Morten
Knudsen, Lisbeth B
Sandall, Jane
author_sort Overgaard, Charlotte
collection PubMed
description OBJECTIVE: To compare perinatal and maternal morbidity and birth interventions in low-risk women giving birth in two freestanding midwifery units (FMUs) and two obstetric units (OUs). DESIGN: A cohort study with a matched control group. SETTING: The region of North Jutland, Denmark. PARTICIPANTS: 839 low-risk women intending FMU birth and a matched control group of 839 low-risk women intending OU birth were included at the start of care in labour. OU women were individually chosen to match selected obstetric/socio-economic characteristics of FMU women. Analysis was by intention to treat. MAIN OUTCOME MEASURES: Perinatal and maternal morbidity and interventions. RESULTS: No significant differences in perinatal morbidity were observed between groups (Apgar scores <7/5, <9/5 or <7/1, admittance to neonatal unit, asphyxia or readmission). Adverse outcomes were rare and occurred in both groups. FMU women were significantly less likely to experience an abnormal fetal heart rate (RR: 0.3, 95% CI 0.2 to 0.5), fetal–pelvic complications (0.2, 0.05 to 0.6), shoulder dystocia (0.3, 0.1 to 0.9), occipital–posterior presentation (0.5, 0.3 to 0.9) and postpartum haemorrhage >500 ml (0.4, 0.3 to 0.6) compared with OU women. Significant reductions were found for the FMU group's use of caesarean section (0.6, 0.3 to 0.9), instrumental delivery (0.4, 0.3 to 0.6), and oxytocin augmentation (0.5, 0.3 to 0.6) and epidural analgesia (0.4, 0.3 to 0.6). Transfer during or <2 h after birth occurred in 14.8% of all FMU births but more frequently in primiparas than in multiparas (36.7% vs 7.2%). CONCLUSION: Comparing FMU and OU groups, there was no increase in perinatal morbidity, but there were significantly reduced incidences of maternal morbidity, birth interventions including caesarean section, and increased likelihood of spontaneous vaginal birth. FMU care may be considered as an adequate alternative to OU care for low-risk women. Pregnant prospective mothers should be given an informed choice of place of birth, including information on transfer.
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spelling pubmed-31916062011-10-13 Freestanding midwifery unit versus obstetric unit: a matched cohort study of outcomes in low-risk women Overgaard, Charlotte Møller, Anna Margrethe Fenger-Grøn, Morten Knudsen, Lisbeth B Sandall, Jane BMJ Open Reproductive Medicine, Obstetrics and Gynaecology OBJECTIVE: To compare perinatal and maternal morbidity and birth interventions in low-risk women giving birth in two freestanding midwifery units (FMUs) and two obstetric units (OUs). DESIGN: A cohort study with a matched control group. SETTING: The region of North Jutland, Denmark. PARTICIPANTS: 839 low-risk women intending FMU birth and a matched control group of 839 low-risk women intending OU birth were included at the start of care in labour. OU women were individually chosen to match selected obstetric/socio-economic characteristics of FMU women. Analysis was by intention to treat. MAIN OUTCOME MEASURES: Perinatal and maternal morbidity and interventions. RESULTS: No significant differences in perinatal morbidity were observed between groups (Apgar scores <7/5, <9/5 or <7/1, admittance to neonatal unit, asphyxia or readmission). Adverse outcomes were rare and occurred in both groups. FMU women were significantly less likely to experience an abnormal fetal heart rate (RR: 0.3, 95% CI 0.2 to 0.5), fetal–pelvic complications (0.2, 0.05 to 0.6), shoulder dystocia (0.3, 0.1 to 0.9), occipital–posterior presentation (0.5, 0.3 to 0.9) and postpartum haemorrhage >500 ml (0.4, 0.3 to 0.6) compared with OU women. Significant reductions were found for the FMU group's use of caesarean section (0.6, 0.3 to 0.9), instrumental delivery (0.4, 0.3 to 0.6), and oxytocin augmentation (0.5, 0.3 to 0.6) and epidural analgesia (0.4, 0.3 to 0.6). Transfer during or <2 h after birth occurred in 14.8% of all FMU births but more frequently in primiparas than in multiparas (36.7% vs 7.2%). CONCLUSION: Comparing FMU and OU groups, there was no increase in perinatal morbidity, but there were significantly reduced incidences of maternal morbidity, birth interventions including caesarean section, and increased likelihood of spontaneous vaginal birth. FMU care may be considered as an adequate alternative to OU care for low-risk women. Pregnant prospective mothers should be given an informed choice of place of birth, including information on transfer. BMJ Group 2011-09-30 /pmc/articles/PMC3191606/ /pubmed/22021892 http://dx.doi.org/10.1136/bmjopen-2011-000262 Text en © 2011, Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions. This is an open-access article distributed under the terms of the Creative Commons Attribution Non-commercial License, which permits use, distribution, and reproduction in any medium, provided the original work is properly cited, the use is non commercial and is otherwise in compliance with the license. See: http://creativecommons.org/licenses/by-nc/2.0/ and http://creativecommons.org/licenses/by-nc/2.0/legalcode.
spellingShingle Reproductive Medicine, Obstetrics and Gynaecology
Overgaard, Charlotte
Møller, Anna Margrethe
Fenger-Grøn, Morten
Knudsen, Lisbeth B
Sandall, Jane
Freestanding midwifery unit versus obstetric unit: a matched cohort study of outcomes in low-risk women
title Freestanding midwifery unit versus obstetric unit: a matched cohort study of outcomes in low-risk women
title_full Freestanding midwifery unit versus obstetric unit: a matched cohort study of outcomes in low-risk women
title_fullStr Freestanding midwifery unit versus obstetric unit: a matched cohort study of outcomes in low-risk women
title_full_unstemmed Freestanding midwifery unit versus obstetric unit: a matched cohort study of outcomes in low-risk women
title_short Freestanding midwifery unit versus obstetric unit: a matched cohort study of outcomes in low-risk women
title_sort freestanding midwifery unit versus obstetric unit: a matched cohort study of outcomes in low-risk women
topic Reproductive Medicine, Obstetrics and Gynaecology
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3191606/
https://www.ncbi.nlm.nih.gov/pubmed/22021892
http://dx.doi.org/10.1136/bmjopen-2011-000262
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