Another study has confirmed that freestanding midwifery units are a safe and reasonable option for mothers and babies and that women who use them are less likely to have a caesarean section, even if transfer is involved (Monk et al 2017).
Australian researchers carried out a descriptive study to compare the maternal and neonatal birth outcomes of two different groups of women. They compared the outcomes of 256 women who planned to give birth at freestanding midwifery units but who transferred to a tertiary maternity unit with 3157 low-risk women who planned to give birth in a tertiary maternity unit.
This is an important study because, although we have lots of research showing that out-of-hospital birth is safe and may be better than hospital birth in some dimensions for healthy women and babies, the rates of transfer from these units to tertiary care is quite high in some areas, and we don’t have much data about how the outcomes of the women and babies who transfer compare to those who booked in tertiary care in the first place. In this study, 168 (65.6%) of the women who were transferred did so during the antenatal period, 65 (25.4%) transferred during the intrapartum period and 18 (7.0%) transferred during the postnatal period. Timing of transfer was unknown for 5 women (2.0%).
The results of the study showed that proportionally fewer of the women who were originally planing to birth in the freestanding midwifery unit experienced a caesarean section than in the group of women who planned to birth at the tertiary unit – 16.1% versus 24.8% respectively.
Other outcomes were comparable between both groups and, although larger studies of various designs are needed to further expand our understanding of this area, the authors conclude that their results support the provision of care in freestanding, midwifery units as an alternative to tertiary maternity units for women who have low risk pregnancies at the time of booking (Monk et al 2017).
Monk AR, Grigg CP, Foureur M et al (2017). Freestanding midwifery units: Maternal and neonatal outcomes following transfer. Midwifery, In Press, Accepted Manuscript. http://dx.doi.org/10.1016/j.midw.2017.01.006
Background: The viability of freestanding midwifery units in Australia is restricted, due to concerns over their safety, particularly for women and babies who, require transfer.
Aim: To compare the maternal and neonatal birth outcomes of women who planned, to give birth at freestanding midwifery units and subsequently, transferred to a tertiary maternity unit to the maternal and neonatal, outcomes of a low-risk cohort of women who planned to give birth in, tertiary maternity unit.
Methods: A descriptive study compared two groups of women with low-risk singleton, pregnancies who were less than 28 weeks pregnant at booking: women who, planned to give birth at a freestanding midwifery unit (n=494) who, transferred to a tertiary maternity unit during the antenatal, intrapartum or postnatal periods (n=260) and women who planned to give, birth at a tertiary maternity unit (n=3,157). Primary outcomes were mode, of birth, Apgar score of less than 7 at 5 minutes and admission to, special care nursery or neonatal intensive care.
Key Findings: The proportion of women who experienced a caesarean section was lower, among the freestanding midwifery unit women who transferred during the, intrapartum/postnatal period compared to women in the tertiary maternity, unit group (16.1% versus 24.8% respectively). Other outcomes were, comparable between the cohorts. Rates of primary outcomes in relation to, stage of transfer varied when stratified by parity.
Discussion: These descriptive results support the provision of care in freestanding, midwifery units as an alternative to tertiary maternity units for women, with low risk pregnancies at the time of booking. A larger study, powered, to determine statistical significance of any differences in outcomes, is, required.