Evaluating Midwifery Units (EMU): A prospective cohort study of freestanding midwifery units in New South Wales, Australia

Monk, A; Tracy, M; Foureur, M; Grigg, C; Tracy, S

Evaluating Midwifery Units (EMU): A prospective cohort study of freestanding midwifery units in New South Wales, Australia

Monk, A

Tracy, M Foureur, M

Grigg, C Tracy, S

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Publication Type:: Journal Article
Citation:: BMJ Open, 2014, 4 (10)
Issue Date:: 2014-01-01

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Field	Value	Language
dc.contributor.author	Monk, A https://orcid.org/0000-0002-0387-0496	en_US
dc.contributor.author	Tracy, M	en_US
dc.contributor.author	Foureur, M https://orcid.org/0000-0002-0454-0165	en_US
dc.contributor.author	Grigg, C	en_US
dc.contributor.author	Tracy, S	en_US
dc.date.issued	2014-01-01	en_US
dc.identifier.citation	BMJ Open, 2014, 4 (10)	en_US
dc.identifier.uri	http://hdl.handle.net/10453/33070
dc.description.abstract	© 2014, BMJ Publishing Group. All rights reserved. Objective: To compare maternal and neonatal birth outcomes and morbidities associated with the intention to give birth in two freestanding midwifery units and two tertiary-level maternity units in New South Wales, Australia. Design: Prospective cohort study. Participants: 494 women who intended to give birth at freestanding midwifery units and 3157 women who intended to give birth at tertiary-level maternity units. Participants had low risk, singleton pregnancies and were at less than 28+0 weeks gestation at the time of booking. Primary and secondary outcome measures: Primary outcomes were mode of birth, Apgar score of less than 7 at 5 min and admission to the neonatal intensive care unit or special care nursery. Secondary outcomes were onset of labour, analgesia, blood loss, management of third stage of labour, perineal trauma, transfer, neonatal resuscitation, breastfeeding, gestational age at birth, birth weight, severe morbidity and mortality. Results: Women who planned to give birth at a freestanding midwifery unit were significantly more likely to have a spontaneous vaginal birth (AOR 1.57; 95% CI 1.20 to 2.06) and significantly less likely to have a caesarean section (AOR 0.65; 95% CI 0.48 to 0.88). There was no significant difference in the AOR of 5 min Apgar scores, however, babies from the freestanding midwifery unit group were significantly less likely to be admitted to neonatal intensive care or special care nursery (AOR 0.60; 95% CI 0.39 to 0.91). Analysis of secondary outcomes indicated that planning to give birth in a freestanding midwifery unit was associated with similar or reduced odds of intrapartum interventions and similar or improved odds of indicators of neonatal well-being. Conclusions: The results of this study support the provision of care in freestanding midwifery units as an alternative to tertiary-level maternity units for women with low risk pregnancies at the time of booking.	en_US
dc.relation.ispartof	BMJ Open	en_US
dc.relation.isbasedon	10.1136/bmjopen-2014-006252	en_US
dc.subject.mesh	Humans	en_US
dc.subject.mesh	Apgar Score	en_US
dc.subject.mesh	Patient Transfer	en_US
dc.subject.mesh	Delivery, Obstetric	en_US
dc.subject.mesh	Cesarean Section	en_US
dc.subject.mesh	Labor, Induced	en_US
dc.subject.mesh	Cohort Studies	en_US
dc.subject.mesh	Prospective Studies	en_US
dc.subject.mesh	Midwifery	en_US
dc.subject.mesh	Pregnancy	en_US
dc.subject.mesh	Adult	en_US
dc.subject.mesh	Infant, Newborn	en_US
dc.subject.mesh	Birthing Centers	en_US
dc.subject.mesh	Delivery Rooms	en_US
dc.subject.mesh	Intensive Care Units, Neonatal	en_US
dc.subject.mesh	Outcome Assessment (Health Care)	en_US
dc.subject.mesh	New South Wales	en_US
dc.subject.mesh	Female	en_US
dc.subject.mesh	Male	en_US
dc.subject.mesh	Outcome Assessment, Health Care	en_US
dc.title	Evaluating Midwifery Units (EMU): A prospective cohort study of freestanding midwifery units in New South Wales, Australia	en_US
dc.type	Journal Article
utslib.citation.volume	10	en_US
utslib.citation.volume	4	en_US
utslib.for	1110 Nursing	en_US
utslib.for	1103 Clinical Sciences	en_US
utslib.for	1117 Public Health and Health Services	en_US
utslib.for	1199 Other Medical and Health Sciences	en_US
pubs.embargo.period	Not known	en_US
pubs.organisational-group	/University of Technology Sydney
pubs.organisational-group	/University of Technology Sydney/Faculty of Health
pubs.organisational-group	/University of Technology Sydney/Faculty of Health/Midwifery
pubs.organisational-group	/University of Technology Sydney/Strength - CHSP - Health Services and Practice
utslib.copyright.status	open_access
pubs.issue	10	en_US
pubs.publication-status	Published	en_US
pubs.volume	4	en_US

Abstract:

© 2014, BMJ Publishing Group. All rights reserved. Objective: To compare maternal and neonatal birth outcomes and morbidities associated with the intention to give birth in two freestanding midwifery units and two tertiary-level maternity units in New South Wales, Australia. Design: Prospective cohort study. Participants: 494 women who intended to give birth at freestanding midwifery units and 3157 women who intended to give birth at tertiary-level maternity units. Participants had low risk, singleton pregnancies and were at less than 28+0 weeks gestation at the time of booking. Primary and secondary outcome measures: Primary outcomes were mode of birth, Apgar score of less than 7 at 5 min and admission to the neonatal intensive care unit or special care nursery. Secondary outcomes were onset of labour, analgesia, blood loss, management of third stage of labour, perineal trauma, transfer, neonatal resuscitation, breastfeeding, gestational age at birth, birth weight, severe morbidity and mortality. Results: Women who planned to give birth at a freestanding midwifery unit were significantly more likely to have a spontaneous vaginal birth (AOR 1.57; 95% CI 1.20 to 2.06) and significantly less likely to have a caesarean section (AOR 0.65; 95% CI 0.48 to 0.88). There was no significant difference in the AOR of 5 min Apgar scores, however, babies from the freestanding midwifery unit group were significantly less likely to be admitted to neonatal intensive care or special care nursery (AOR 0.60; 95% CI 0.39 to 0.91). Analysis of secondary outcomes indicated that planning to give birth in a freestanding midwifery unit was associated with similar or reduced odds of intrapartum interventions and similar or improved odds of indicators of neonatal well-being. Conclusions: The results of this study support the provision of care in freestanding midwifery units as an alternative to tertiary-level maternity units for women with low risk pregnancies at the time of booking.

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http://hdl.handle.net/10453/33070