Article Text

Download PDFPDF

Maternal and perinatal outcomes by planned place of birth in Australia 2000 – 2012: a linked population data study
  1. Caroline S E Homer1,2,
  2. Seong L Cheah1,
  3. Chris Rossiter1,
  4. Hannah G Dahlen3,
  5. David Ellwood4,
  6. Maralyn J Foureur1,
  7. Della A Forster5,6,
  8. Helen L McLachlan5,7,
  9. Jeremy J N Oats8,
  10. David Sibbritt9,
  11. Charlene Thornton10,
  12. Vanessa L Scarf1
  1. 1 Centre for Midwifery, Child and Family Health, University of Technology Sydney, Sydney, New South Wales, Australia
  2. 2 Maternal and Child Health, Burnet Institute, Melbourne, Victoria, Australia
  3. 3 School of Nursing and Midwifery, University of Western Sydney, Parramatta, New South Wales, Australia
  4. 4 School of Medicine, Griffith University, Gold Coast, Queensland, Australia
  5. 5 Judith Lumley Centre, La Trobe University, Melbourne, Victoria, Australia
  6. 6 Maternity Services, Royal Women's Hospital, Parkville, Victoria, Australia
  7. 7 School of Nursing and Midwifery, La Trobe University, Bundoora, Victoria, Australia
  8. 8 Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
  9. 9 Faculty of Health, University of Technology Sydney, Sydney, New South Wales, Australia
  10. 10 College of Nursing and Health Sciences, Flinders University Faculty of Medicine Nursing and Health Sciences, Adelaide, South Australia, Australia
  1. Correspondence to Professor Caroline S E Homer; caroline.homer{at}uts.edu.au

Abstract

Objective To compare perinatal and maternal outcomes for Australian women with uncomplicated pregnancies according to planned place of birth, that is, in hospital labour wards, birth centres or at home.

Design A population-based retrospective design, linking and analysing routinely collected electronic data. Analysis comprised χ2 tests and binary logistic regression for categorical data, yielding adjusted ORs. Continuous data were analysed using analysis of variance.

Setting All eight Australian states and territories.

Participants Women with uncomplicated pregnancies who gave birth between 2000 and 2012 to a singleton baby in cephalic presentation at between 37 and 41 completed weeks’ gestation. Of the 1 251 420 births, 1 171 703 (93.6%) were planned in hospital labour wards, 71 505 (5.7%) in birth centres and 8212 (0.7%) at home.

Main outcome measures Mode of birth, normal labour and birth, interventions and procedures during labour and birth, maternal complications, admission to special care/high dependency or intensive care units (mother or infant) and perinatal mortality (intrapartum stillbirth and neonatal death).

Results Compared with planned hospital births, the odds of normal labour and birth were over twice as high in planned birth centre births (adjusted OR (AOR) 2.72; 99% CI 2.63 to 2.81) and nearly six times as high in planned home births (AOR 5.91; 99% CI 5.15 to 6.78). There were no statistically significant differences in the proportion of intrapartum stillbirths, early or late neonatal deaths between the three planned places of birth.

Conclusions This is the first Australia-wide study to examine outcomes by planned place of birth. For healthy women in Australia having an uncomplicated pregnancy, planned births in birth centres or at home are associated with positive maternal outcomes although the number of homebirths was small overall. There were no significant differences in the perinatal mortality rate, although the absolute numbers of deaths were very small and therefore firm conclusions cannot be drawn about perinatal mortality outcomes.

  • maternal medicine
  • epidemiology
  • perinatology

This is an open access article distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited, appropriate credit is given, any changes made indicated, and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/.

View Full Text

Statistics from Altmetric.com

Footnotes

  • Twitter @CarolineHomer, @hannahdahlen, @VScarf

  • Contributors CSEH as the lead investigator was responsible for the overall leadership of the study including the initial conception and design, grant application, ethical approval processes, leading the project, drafting the manuscript and finalising the paper. SLC was the data analyst responsible for merging the datasets from each jurisdiction, refining the datasets, developing the analysis codes and processes and conducting the statistical analysis and has provided final approval of this version. CR worked with the data analyst to support data analysis and interpretation as well as taking a key role in supporting the drafting of the manuscript and has provided final approval of this version. HGD was involved in the initial design of the study, played a key role in developing the study questions and data analytic processes, was involved in drafting the work and/or revising it critically for important intellectual content and has provided final approval of this version. DE, MJF, DAF, HLM and JJNO were involved in the initial design of the study, played a key role in developing the study questions and providing expert review, was involved in drafting the work and/or revising it critically for important intellectual content and has provided final approval of this version. DS was involved in the initial design of the study, played a key role in developing the study questions and analytic processes and providing expert statistical planning and review, was involved in drafting the work and/or revising it critically for important intellectual content and has provided final approval of this version. CT played a key role in developing the study questions and analytic plan, assisted with planning the data set merging and cleaning of the data and providing expert epidemiological review, was involved in drafting the work and/or revising it critically for important intellectual content and has provided final approval of this version. VS was the project coordinator responsible for the ethical approval processes, took a key role in coordinating the acquisition of the data from the different states and territories as well as a lead role in planning and undertaking the analysis and interpretation, was involved in drafting the work and/or revising it critically for important intellectual content and has provided final approval of this version.

  • Funding This work was supported by the National Health and Medical Research Council Australia, Grant ID 1022422 (2012–2017).

  • Competing interests None declared.

  • Patient consent for publication Not required.

  • Ethics approval The study received initial ethical approval from the lead university’s Human Research Ethics Committee (HREC) (university reference number: 2012000167) and from data custodians in each state and territory. The details are provided in a Supplementary File.

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

  • Data availability statement The data are not publicly available. We are not permitted to make any part of the linked data available to any party outside those named on the research team who have been granted access.

Request Permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.