The Stockholm Birth Centre Trial: maternal and infant outcome

Authors

  • Ulla Waldenstrom,

    Professor , Corresponding author
    1. Graduate Clinical School of Midwifery and Women s Health, La Trobe University, Melbourne, Australia
      Correspondence: Professor U. Waldenstrom, Graduate Clinical School of Midwifery and Women's Health, La Trobe University, Royal Women's Hospital Campus, 132 Grattan Street, Carlton, Victoria, Australia 3053.
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  • Carl-Axel Nilsson,

    Senior Research Officer (Obstetrics)
    1. Swedish Institute for Health Services Development (Spri), Stockholm
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  • Birger Winbladh

    Associate Professor
    1. Kamlinska Institute, Department of Pediatrics, Sachs’ Children s Hospital, Stockholm
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Correspondence: Professor U. Waldenstrom, Graduate Clinical School of Midwifery and Women's Health, La Trobe University, Royal Women's Hospital Campus, 132 Grattan Street, Carlton, Victoria, Australia 3053.

Abstract

Objective To compare an in-hospital birth centre with standard maternity care regarding medical interventions and maternal and infant outcome.

Background The birth centre care was characterised by comprehensive antenatal, intrapartum and postpartum care with the same team of midwives, restricted use of medical technology, and discharge within 24 h after birth.

Methods Of 1860 women meeting low risk medical criteria in early pregnancy and interested in birth centre care, 928 were randomly allotted birth centre care and 932 standard maternity care. Data were collected mainly from hospital records, and analysis was by intention-to-treat.

Results Of the women in the birth centre group, 13% were transferred antenatally and 19% intrapartum. No statistical differences were observed in maternal morbidity or in perinatal mortality, neonatal morbidity, Apgar score or infant admissions to neonatal care. Perinatal mortality, defined as intrauterine death after 22 weeks of gestation and infant death within seven days of birth, occurred in eight cases (0.9%) in the birth centre group and in two cases (0.2%) in the standard care group (OR 4.04, 95% CI 0.80 to 39.17; P= 0.11). Subgroup analysis showed that a larger proportion of first-born babies in the birth centre group (15.6%) were admitted for neonatal care than in the standard care group (9.5%) (P= 0.003), whereas the converse was the case for the newborns of multiparous women: 4.7% and 8.4%, respectively (P= 0.04). The overall rates of operative delivery (e.g. caesarean section, vacuum extraction and forceps), 11.1% in the birth centre group and 13.4% in the standard care group, did not differ statistically (P= 0.12), but obstetric analgesia, induction, augmentation of labour and electronic fetal monitoring were less frequently used in the birth centre group. Labour was 1 h longer in the birth centre group.

Conclusion Birth centre care was associated with less medical interventions than standard care without any statistically significant differences in health outcomes. However, the excess of perinatal deaths and of morbidity in primigravidas’ infants in the birth centre group gives cause for concern and necessitates further studies.

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