Comparing Perinatal Outcomes for Healthy Pregnant Women Presenting at Primary and Tertiary Settings in South Auckland: A Retrospective Cohort Study

Date
2019
Authors
Farry, A
McAra-Couper, J
Wheldon, M
Clemons, JH
Supervisor
Item type
Journal Article
Degree name
Journal Title
Journal ISSN
Volume Title
Publisher
New Zealand College of Midwives
Abstract

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.

Description
Keywords
Place of Birth , Primary birthing unit , Tertiary maternity hospital , Caesarean section , Neonatal morbidity , Transfer rates
Source
New Zealand College of Midwives Journal, 55, pp. 5-13. https://doi.org/10.12784/nzcomjnl55.2019.1.5-13
Rights statement
The Journal is double-blind peer reviewed and uses electronic, article-based publishing to provide open access to all papers as they are published. It is then printed in full in December each year and circulated to all College members and subscribers.