Planned Place of Birth in New Zealand: Does it Affect Mode of Birth and Intervention Rates Among Low-Risk Women?

Authors

  • Deborah Davis RM, MNS, PhD,

    1. Deborah Davis is an Associate Professor at the Centre for Midwifery, Child and Family Health at the University of Technology, and South Eastern Sydney Illawarra Area Health Service, Sydney, Australia; Peter Herbison is Professor of Biostatistics with the Department of Preventive and Social Medicine, University of Otago, Dunedin; Sally Baddock is the Associate Head, School of Midwifery, Dunedin; Sally Pairman is the Group Manager of Health and Community at Otago Polytechnic, Dunedin; Marion Hunter is a Senior Lecturer with the School of Midwifery, Auckland University of Technology, Auckland; Cheryl Benn is Associate Professor with the School of Health and Social Services at Massey University, Palmerston North; and Lesley Dixon is the Midwifery Advisor for the New Zealand College of Midwives, Christchurch, New Zealand.
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  • Sally Baddock BSc, DipTchng, PhD,

    1. Deborah Davis is an Associate Professor at the Centre for Midwifery, Child and Family Health at the University of Technology, and South Eastern Sydney Illawarra Area Health Service, Sydney, Australia; Peter Herbison is Professor of Biostatistics with the Department of Preventive and Social Medicine, University of Otago, Dunedin; Sally Baddock is the Associate Head, School of Midwifery, Dunedin; Sally Pairman is the Group Manager of Health and Community at Otago Polytechnic, Dunedin; Marion Hunter is a Senior Lecturer with the School of Midwifery, Auckland University of Technology, Auckland; Cheryl Benn is Associate Professor with the School of Health and Social Services at Massey University, Palmerston North; and Lesley Dixon is the Midwifery Advisor for the New Zealand College of Midwives, Christchurch, New Zealand.
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  • Sally Pairman MNZM, RM, DMid,

    1. Deborah Davis is an Associate Professor at the Centre for Midwifery, Child and Family Health at the University of Technology, and South Eastern Sydney Illawarra Area Health Service, Sydney, Australia; Peter Herbison is Professor of Biostatistics with the Department of Preventive and Social Medicine, University of Otago, Dunedin; Sally Baddock is the Associate Head, School of Midwifery, Dunedin; Sally Pairman is the Group Manager of Health and Community at Otago Polytechnic, Dunedin; Marion Hunter is a Senior Lecturer with the School of Midwifery, Auckland University of Technology, Auckland; Cheryl Benn is Associate Professor with the School of Health and Social Services at Massey University, Palmerston North; and Lesley Dixon is the Midwifery Advisor for the New Zealand College of Midwives, Christchurch, New Zealand.
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  • Marion Hunter RM, BA, MA (Hons),

    1. Deborah Davis is an Associate Professor at the Centre for Midwifery, Child and Family Health at the University of Technology, and South Eastern Sydney Illawarra Area Health Service, Sydney, Australia; Peter Herbison is Professor of Biostatistics with the Department of Preventive and Social Medicine, University of Otago, Dunedin; Sally Baddock is the Associate Head, School of Midwifery, Dunedin; Sally Pairman is the Group Manager of Health and Community at Otago Polytechnic, Dunedin; Marion Hunter is a Senior Lecturer with the School of Midwifery, Auckland University of Technology, Auckland; Cheryl Benn is Associate Professor with the School of Health and Social Services at Massey University, Palmerston North; and Lesley Dixon is the Midwifery Advisor for the New Zealand College of Midwives, Christchurch, New Zealand.
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  • Cheryl Benn RM, MCur, DCur,

    1. Deborah Davis is an Associate Professor at the Centre for Midwifery, Child and Family Health at the University of Technology, and South Eastern Sydney Illawarra Area Health Service, Sydney, Australia; Peter Herbison is Professor of Biostatistics with the Department of Preventive and Social Medicine, University of Otago, Dunedin; Sally Baddock is the Associate Head, School of Midwifery, Dunedin; Sally Pairman is the Group Manager of Health and Community at Otago Polytechnic, Dunedin; Marion Hunter is a Senior Lecturer with the School of Midwifery, Auckland University of Technology, Auckland; Cheryl Benn is Associate Professor with the School of Health and Social Services at Massey University, Palmerston North; and Lesley Dixon is the Midwifery Advisor for the New Zealand College of Midwives, Christchurch, New Zealand.
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  • Don Wilson MD, FRCOG, FRANZCOG,

    1. Deborah Davis is an Associate Professor at the Centre for Midwifery, Child and Family Health at the University of Technology, and South Eastern Sydney Illawarra Area Health Service, Sydney, Australia; Peter Herbison is Professor of Biostatistics with the Department of Preventive and Social Medicine, University of Otago, Dunedin; Sally Baddock is the Associate Head, School of Midwifery, Dunedin; Sally Pairman is the Group Manager of Health and Community at Otago Polytechnic, Dunedin; Marion Hunter is a Senior Lecturer with the School of Midwifery, Auckland University of Technology, Auckland; Cheryl Benn is Associate Professor with the School of Health and Social Services at Massey University, Palmerston North; and Lesley Dixon is the Midwifery Advisor for the New Zealand College of Midwives, Christchurch, New Zealand.
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  • Lesley Dixon RM, MMid,

    1. Deborah Davis is an Associate Professor at the Centre for Midwifery, Child and Family Health at the University of Technology, and South Eastern Sydney Illawarra Area Health Service, Sydney, Australia; Peter Herbison is Professor of Biostatistics with the Department of Preventive and Social Medicine, University of Otago, Dunedin; Sally Baddock is the Associate Head, School of Midwifery, Dunedin; Sally Pairman is the Group Manager of Health and Community at Otago Polytechnic, Dunedin; Marion Hunter is a Senior Lecturer with the School of Midwifery, Auckland University of Technology, Auckland; Cheryl Benn is Associate Professor with the School of Health and Social Services at Massey University, Palmerston North; and Lesley Dixon is the Midwifery Advisor for the New Zealand College of Midwives, Christchurch, New Zealand.
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  • Peter Herbison MSc

    1. Deborah Davis is an Associate Professor at the Centre for Midwifery, Child and Family Health at the University of Technology, and South Eastern Sydney Illawarra Area Health Service, Sydney, Australia; Peter Herbison is Professor of Biostatistics with the Department of Preventive and Social Medicine, University of Otago, Dunedin; Sally Baddock is the Associate Head, School of Midwifery, Dunedin; Sally Pairman is the Group Manager of Health and Community at Otago Polytechnic, Dunedin; Marion Hunter is a Senior Lecturer with the School of Midwifery, Auckland University of Technology, Auckland; Cheryl Benn is Associate Professor with the School of Health and Social Services at Massey University, Palmerston North; and Lesley Dixon is the Midwifery Advisor for the New Zealand College of Midwives, Christchurch, New Zealand.
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  • This research was supported by a research grant from Otago Polytechnic, Dunedin, New Zealand.

Address correspondence to Deborah Davis, RM, MNS, PhD, Centre for Midwifery, Child and Family Health, University of Technology, Sydney, PO Box 123, Broadway, NSW 2007, Australia.

Abstract

Abstract:  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 low-risk 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. (BIRTH 38:2 June 2011)

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