Self-Rated “No-” and “Low-” Risk Pregnancy: A Comparison of Outcomes for Women in Obstetric-Led and Midwife-Led Units in England

Authors

  • Andrew G. Symon RM, MA(Hons), PhD,

    Corresponding author
    1. 1Andrew G. Symon is a Senior Lecturer, School of Nursing & Midwifery, 2Jeanette Paul is Head of Design, School of Design, 3Maggie Butchart is a Doctoral Candidate, School of Nursing & Midwifery, and 4Val Carr is a Doctoral Candidate, School of Design, University of Dundee; and 5Pat Dugard is an Independent Statistician, Dundee, Scotland.
      Dr. Andrew G. Symon, RM, MA(Hons), PhD, School of Nursing & Midwifery, University of Dundee, Dundee DD1 9SY, Scotland.
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  • 1 Jeanette Paul BSc, BArch(Hons), RIBA, RIAS,

    1. 1Andrew G. Symon is a Senior Lecturer, School of Nursing & Midwifery, 2Jeanette Paul is Head of Design, School of Design, 3Maggie Butchart is a Doctoral Candidate, School of Nursing & Midwifery, and 4Val Carr is a Doctoral Candidate, School of Design, University of Dundee; and 5Pat Dugard is an Independent Statistician, Dundee, Scotland.
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  • 2 Maggie Butchart MA(Hons), MSc,

    1. 1Andrew G. Symon is a Senior Lecturer, School of Nursing & Midwifery, 2Jeanette Paul is Head of Design, School of Design, 3Maggie Butchart is a Doctoral Candidate, School of Nursing & Midwifery, and 4Val Carr is a Doctoral Candidate, School of Design, University of Dundee; and 5Pat Dugard is an Independent Statistician, Dundee, Scotland.
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  • 3 Val Carr BA, MSc,

    1. 1Andrew G. Symon is a Senior Lecturer, School of Nursing & Midwifery, 2Jeanette Paul is Head of Design, School of Design, 3Maggie Butchart is a Doctoral Candidate, School of Nursing & Midwifery, and 4Val Carr is a Doctoral Candidate, School of Design, University of Dundee; and 5Pat Dugard is an Independent Statistician, Dundee, Scotland.
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  • and 4 Pat Dugard MA, PG, Dip(MathStat) 5

    1. 1Andrew G. Symon is a Senior Lecturer, School of Nursing & Midwifery, 2Jeanette Paul is Head of Design, School of Design, 3Maggie Butchart is a Doctoral Candidate, School of Nursing & Midwifery, and 4Val Carr is a Doctoral Candidate, School of Design, University of Dundee; and 5Pat Dugard is an Independent Statistician, Dundee, Scotland.
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  • The study was funded by NHS Estates, Department of Health, London, United Kingdom.

Dr. Andrew G. Symon, RM, MA(Hons), PhD, School of Nursing & Midwifery, University of Dundee, Dundee DD1 9SY, Scotland.

Abstract

ABSTRACT: Background: Debate in the United Kingdom about place of birth often concerns obstetric-led units and midwife-led units and relates to notions of risk and safety. Outcomes for these two types of unit are often not comparable because of the restricted selection criteria for midwife-led units. The purpose of this study was to compare outcomes for women intending to give birth in these different types of unit and whose self-rated pregnancy risk level was “none” or “low.” Methods: Self-completion questionnaires were distributed to mothers 8 days after the birth in 9 units (6 midwife led 3 obstetric led) over a 6-month period.Results: Completed questionnaires were received from 432 women (midwife led = 294, obstetric led = 138). Mothers in midwife-led units spent shorter times in labor in the unit (< 0.01), received less analgesia (< 0.01) and had fewer interventions (< 0.01), and were more likely to have a normal delivery (< 0.01) than women in obstetric-led units. Similar differences were found for both primiparous and multiparous women. In terms of the number of midwives attending each woman, analysis of covariance suggested different models of care depending on type of unit (< 0.05) and parity (< 0.01).Conclusions: Since these mothers’ self-rated risk level was none or low, some comparability of outcomes is permissible. It appears that models of care are significantly different in obstetric-led units compared with midwife-led units, leading to greater likelihood of intrapartum intervention, need for analgesia, and assisted or operative delivery. A randomized controlled trial examining such units would permit a conclusive examination of these outcomes. (BIRTH 34:4 December 2007)

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