Comparing Perinatal Outcomes for Healthy Pregnant Women Presenting at Primary and Tertiary Settings in South Auckland: A Retrospective Cohort Study
Farry, A; McAra-Couper, J; Wheldon, M; Clemons, JH
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ABSTRACT Background: Strong evidence supports the premise that many low-risk women and babies experience perinatal outcomes, in a free-standing, midwifery-led, primary level maternity unit (PMU) similar to, or better than, those of an obstetric-led tertiary level maternity hospital (TMH). Aim: The aim of this study was to identify whether place of birth affected measurable maternal and neonatal outcomes in a low-risk cohort within one New Zealand District Health Board. Method: We gathered the birth records of a retrospective cohort of low-risk women (n=4,207), who had birthed within two distinct environments, including one TMH and three PMUs. Comparison was made of three maternal outcomes: emergency caesarean section, acute postpartum admission to theatre/high dependency unit/intensive care unit (<12hr post birth) and postpartum haemorrhage (PPH; >500ml). Neonatal outcomes analysed were 5-min Apgar score <7 and acute neonatal admission to neonatal intensive care unit (NICU; <12hr post birth). Findings: Logistic regression of data revealed statistically significant associations between place of birth and the five perinatal outcomes. Low-risk women giving birth in one of the three PMUs had fewer emergency caesarean sections (OR 0.25, 95% CI, 0.157-0.339), PPHs (OR 0.692, 95% CI, 0.534-0.898), and acute postpartum admissions to theatre (OR 0.201, 95% CI, 0.102-0.398) than women giving birth in the TMH. Babies born to women at a PMU were less likely to experience a 5-min Apgar <7 (OR 0.313, 95% CI, 0.124-0.791) or acute neonatal admission to NICU (OR 0.492, 95% CI, 0.324-0.747) compared to babies of women of similar risk status, born in the TMH. Conclusion: Low-risk women birthing in PMUs in South Auckland, New Zealand, experienced a significant reduction in morbidity for themselves and their babies.