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BMJ Open 1:e000262 doi:10.1136/bmjopen-2011-000262
  • Reproductive medicine, obstetrics and gynaecology
    • Research

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

  1. Jane Sandall5
  1. 1Department of Sociology and Social Work, Aalborg University, Aalborg, Denmark
  2. 2Aalborg University Hospital, Reberbansgade, Aalborg, Denmark
  3. 3Department of Clinical Epidemiology, Aarhus University Hospital, Aarhus N, Denmark
  4. 4Research Unit for General Practice, Aarhus University, Aarhus C, Denmark
  5. 5Division of Women's Health, School of Medicine, King's College London, St Thomas' Hospital, Westminster Bridge Road, London, UK
  1. Correspondence to Charlotte Overgaard; cho{at}stofanet.dk
  • Received 19 July 2011
  • Accepted 19 August 2011
  • Published 30 September 2011

Abstract

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.

Footnotes

  • Correction notice The “To cite: …” information and running footer in this article have been updated with the correct volume number (volume 1).

  • To cite: Overgaard C, Møller AM, Fenger-Grøn M, et al. Freestanding midwifery unit versus obstetric unit: a matched cohort study of outcomes in low-risk women. BMJ Open 2011;1:e000262. doi:10.1136/bmjopen-2011-000262

  • Funding The study was funded by grants from: the Augustinus Foundation, the Obel Family Foundation, the Oticon Foundation, the University College North Jutland Research and Development Fund, and the Danish Association of Midwives Research and Development Fund, all of which are gratefully acknowledged.

  • Competing interests None.

  • Ethics approval Ethics approval was provided by Danish Data Protection Agency (reference number: 2005-41-5352).

  • Contributors CO was responsible for the study's conceptual design, designed the data collection tools, monitored all data collection, cleaned the data, and participated in the analysis and interpretation of data. She also drafted the article and wrote the final version. She is guarantor. AMM participated in the conceptual design of the study and the interpretation of data. MF-G participated in the analysis of data. LBK and JS participated in the interpretation of data. All of the authors critically revised the manuscript for important intellectual content, and read and approved the final version that was submitted for publication.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement No additional data available.

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.

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