Sammanfattning
BACKGROUND: Midwife-led birth units form a part of the differentiated and decentralised delivery of maternity care services in Norway. The purpose of this study was to investigate the incidence and characteristics of planned and unplanned births in midwife-led birth units, reasons for transfers to hospital, and the outcomes for mother and child.
MATERIAL AND METHOD: In the period between 2008 and 2010, a supplementary form was used for submitting data to the Medical Birth Registry, in addition to the routine report. These forms were filled in by the attending midwife for 2 514 deliveries in midwife-led birth units, out of a total of 2 556 (98.4 %), and for 220 deliveries that had been planned for a midwife-led birth unit, but where the birth took place elsewhere. Data obtained from the completed supplementary forms were then linked with the reports routinely submitted to the Medical Birth Registry, after which the outcomes from births in midwife-led birth units were compared to the outcomes from a low-risk birthing population in hospital.
RESULTS: Among the 2 514 deliveries in midwife-led birth units, 2 320 of them (92.3 %) had been planned for this birthplace, while 194 had not (7.7 %). Among the planned midwife-led birth units deliveries, the total intrapartum transfer rate was 6.9 %. Of these, 19.5 % were nulliparous women. In standard midwife-led birth units, 0.4 % of all births were operative vaginal deliveries, while in modified midwife-led birth units, the operative delivery rate was 3.5 %. Among transfers from a midwife-led birth unit to a hospital, the operative delivery rate was 12.7 %. Among children born in a midwife-led birth unit, 0.6 % had an Apgar score of < 7 after 5 minutes, compared to 1.0 % among children born in the low-risk comparison group in hospital (p = 0.04).
INTERPRETATION: Midwife-led birth units should submit outcomes for all women selected for giving birth there, irrespective of whether the delivery actually took place in a midwife-led birth unit or elsewhere.