Our midwife-led birth unit on hospital grounds – a field report

Introduction:

In Switzerland, the majority of births take place in hospital settings. However, there is a trend towards giving birth at a midwife-led birth unit (MLBU). Our perinatal centre (PC) is the first offering delivery at a MLBU on hospital grounds. The aim of this field report was to evaluate quality features of this seminal project, which combines the low intervention rate of MLBUs with the safety offered by the proximity to a PC.

Methods:

Women with no pre-existing disease, an uncomplicated singleton pregnancy and term births were eligible to deliver at the MLBU. Medical reports of all women admitted to the MLBU in 2018 were retrospectively analysed and evaluated using the following criteria: Transfer rate to the PC, rate of interventions during labour (epidural anaesthesia, oxytocin administration), reason for interventions, and mode of delivery. All women admitted to the MLBU were followed up with a questionnaire assessing the couple“s satisfaction with their birthing experience.

Results:

Of 112 women admitted to the MLBU, 28 (25%) were transferred to the PC during delivery. Twelve were transferred due to failure to progress in the first stage of labour, nine because of labour pain, five because of failure to progress in the second stage of labour, one woman because of suspected preeclampsia, and one woman for induction of labour 24 hours after premature rupture of the membranes. Two women were transferred in the third stage of labour. Twenty-three women (20.5%) received intravenous oxytocin and 18 women (16%) had an epidural anaesthesia. In total, 76.8% of women did not need any medical intervention. One hundred and eight (96.4%) women had a vaginal birth and four women (3.6%) had a caesarean section. Of the 28 women transferred to the PC, 85.7% had a vaginal birth and 14.3% had a caesarean section. There were no critical incidents before or after transferral. All women transferred to the PC were primiparous. Of 112 women filling out the questionnaire, 98.3% stated to be satisfied (4.5%) or very satisfied (93.8%) with the overall quality of their birthing experience.

Conclusion:

The MLBU on hospital grounds is safe for mother and child and allows women to give birth vaginally also after transfer to the maternity ward. Patient satisfaction was very high, regardless of whether the women had been transferred to the PC or not. Comparing our data to a report by the Swiss association of midwife-led birth units (SAMLBU) of the year 2016, our transferral rate was higher (25% versus 17%). However, our rate of caesareans was lower (3.6% versus 9%). Even after transferal, women had a remarkable chance of giving birth vaginally. The defining quality features of the MLBU are not yet conclusively determined. A case-control study will allow comparing outcomes between low risk women admitted to the MLBU and those admitted to the PC.

Reference:

http://www.geburtshaus.ch/documents/upload/STAT_publique_2016_Statistik-Bericht_2016_IGGH-CH_df-2.pdf