Planned Place of Birth in New Zealand: Does it Affect Mode of Birth and Intervention Rates Among Low-Risk Women?
Deborah Davis, Sally Baddock, Sally Pairman, Marion Hunter, Cheryl Benn, Don Wilson, Lesley Dixon and Peter Herbison.
BIRTH 38:2 June 2011
Background: Midwives providing care as lead maternity caregivers in New Zealand provide continuity of care to women who may give birth in a variety of settings, including home, primary units, and secondary and tertiary level hospitals. The purpose of this study was to compare mode of birth and intrapartum intervention rates for low-risk women planning to give birth in these settings under the care of midwives.
Methods: Data for a cohort of lowrisk women giving birth in 2006 and 2007 were extracted from the Midwifery Maternity Provider Organisation database. Mode of birth, intrapartum interventions, and neonatal outcomes were compared with results adjusted for age, parity, ethnicity, and smoking.
Results: Women planning to give birth in secondary and tertiary hospitals had a higher risk of cesarean section, assisted modes of birth, and intrapartum interventions than similar women planning to give birth at home and in primary units. The risk of emergency cesarean section for women planning to give birth in a tertiary unit was 4.62 (95% CI: 3.66–5.84) times that of a woman planning to give birth in a primary unit. Newborns of women planning to give birth in secondary and tertiary hospitals also had a higher risk of admission to a neonatal intensive care unit (RR: 1.40, 95% CI: 1.05–1.87; RR: 1.78, 95% CI: 1.31–2.42) than women planning to give birth in a primary unit.
Conclusions: Planned place of birth has a significant influence on mode of birth and rates of intrapartum intervention in childbirth.
Place of birth and outcomes for a cohort of low risk women in New Zealand: A comparison with Birthplace England
Lesley Dixon, Gail Prileszky, Karen Guilliland, Suzanne Miller, Jacqui Anderson.
New Zealand College of Midwives • Journal 50
Background: Choice, safety and availability of different birth settings are important issues for women and midwives in New Zealand (NZ). In England, the Birthplace England Research Study (BPE) has provided detailed information on outcomes for low risk women related to place of birth. These outcomes cannot be generalised to New Zealand owing to differences in context, culture and models of maternity care. Aim: This observational study has used retrospective data to determine demographic differences between planned birth place setting, neonatal outcomes and transfer rates for a cohort of low risk New Zealand women and compared these findings where possible with those of the Birthplace England research.
Method: Data from the New Zealand College of Midwives Clinical Outcomes Research (NZCOMCORD) database were analysed for the years 2006 to 2010 inclusive for low risk women. Comparisons have been made between place of birth (home, primary unit) and parity, ethnicity, age, body mass index, transfer rates, and neonatal outcomes (Apgars, NICU admission, perinatal mortality).
Results: There were 61,072 women considered low risk, of whom 8% had planned a home birth and 16.6% a primary unit birth. Women who planned to birth at home in New Zealand were older and more likely to be multiparous. These were similar findings to those of the Birthplace England study. The rates of transfer from home (16.9%) or primary unit (12.6%) to hospital were lower than the Birthplace England cohort (21%). There was a higher proportion of nulliparous women (35%) in the planned homebirth group who transferred although this was significantly lower than the Birthplace England cohort (45%) (P<0.002). NZ Māori are the indigenous ethnicity of New Zealand, and a greater proportion of Māori planned birth in a primary unit (27.2%) than a secondary unit (23.2%), home (17.4%) or tertiary hospital (11.1%). The actual number of perinatal mortality outcomes was low across all settings for low risk women in New Zealand and differences in birthplace were not statistically significant (p < 0.14).
Conclusion: A greater proportion of indigenous New Zealand women planned to birth at home or in a primary unit. Fewer women were transferred in labour in the NZ study. This research further refines our understanding of who plans to birth where, and reinforces the evidence that, where a low risk woman plans to birth in NZ, does not significantly increase adverse outcomes for her baby.