In-Hospital Birth Center with the Same Medical Guidelines as Standard Care: A Comparative Study of Obstetric Interventions and Outcomes

Authors

  • Karin Gottvall RN, RM, MSc, PhD,

    1. Karin Gottvall is a Senior Researcher at the Karolinska Institutet, Department of Public Health Sciences, Division of Global Health (IHCAR); Ulla Waldenström is a Professor at the Karolinska Institutet, Department of Women’s and Children’s Health, Division of Reproductive and Perinatal Health; Charlotta Tingstig is a Midwife at South General Hospital (Södersjukhuset, Södra BB); and Charlotta Grunewald is an Associate Professor and Senior Obstetrician at the Karolinska Institutet, Department of Clinical Science and Education, Division of Obstetrics and Gynecology, Södersjukhuset, Stockholm, Sweden.
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  • Ulla Waldenström RN, RM, BA, PhD,

    1. Karin Gottvall is a Senior Researcher at the Karolinska Institutet, Department of Public Health Sciences, Division of Global Health (IHCAR); Ulla Waldenström is a Professor at the Karolinska Institutet, Department of Women’s and Children’s Health, Division of Reproductive and Perinatal Health; Charlotta Tingstig is a Midwife at South General Hospital (Södersjukhuset, Södra BB); and Charlotta Grunewald is an Associate Professor and Senior Obstetrician at the Karolinska Institutet, Department of Clinical Science and Education, Division of Obstetrics and Gynecology, Södersjukhuset, Stockholm, Sweden.
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  • Charlotta Tingstig RN, RM, BSc,

    1. Karin Gottvall is a Senior Researcher at the Karolinska Institutet, Department of Public Health Sciences, Division of Global Health (IHCAR); Ulla Waldenström is a Professor at the Karolinska Institutet, Department of Women’s and Children’s Health, Division of Reproductive and Perinatal Health; Charlotta Tingstig is a Midwife at South General Hospital (Södersjukhuset, Södra BB); and Charlotta Grunewald is an Associate Professor and Senior Obstetrician at the Karolinska Institutet, Department of Clinical Science and Education, Division of Obstetrics and Gynecology, Södersjukhuset, Stockholm, Sweden.
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  • Charlotta Grunewald MD, PhD

    1. Karin Gottvall is a Senior Researcher at the Karolinska Institutet, Department of Public Health Sciences, Division of Global Health (IHCAR); Ulla Waldenström is a Professor at the Karolinska Institutet, Department of Women’s and Children’s Health, Division of Reproductive and Perinatal Health; Charlotta Tingstig is a Midwife at South General Hospital (Södersjukhuset, Södra BB); and Charlotta Grunewald is an Associate Professor and Senior Obstetrician at the Karolinska Institutet, Department of Clinical Science and Education, Division of Obstetrics and Gynecology, Södersjukhuset, Stockholm, Sweden.
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  • This study was supported by research grants from the Stockholm County Council, Stockholm, Sweden.

Address correspondence to Karin Gottvall, RN, RM, MSc, PhD, Radhusallén 9, SE-167 54 Bromma, Sweden.

Abstract:

Background:  A challenge of obstetric care is to optimize maternal and infant health outcomes and the mother’s experience of childbirth with the least possible intervention in the normal process. The aim of this study was to investigate the effects of modified birth center care on obstetric procedures during delivery and on maternal and neonatal outcomes.

Methods:  In a cohort study 2,555 women who signed in for birth center care during pregnancy were compared with all 9,382 low-risk women who gave birth in the standard delivery ward in the same hospital from March 2004 to July 2008. Odds ratios (OR) were calculated with 95% confidence interval (CI) and adjusted for maternal background characteristics, elective cesarean section, and gestational age.

Results:  The modified birth center group included fewer emergency cesarean sections (primiparas: OR: 0.69, 95% CI: 0.58–0.83; multiparas: OR: 0.34, 95% CI: 0.23–0.51), and in multiparas the vacuum extraction rate was reduced (OR: 0.42, 95% CI: 0.26–0.67). In addition, epidural analgesia was used less frequently (primiparas: OR: 0.47, 95% CI: 0.41–0.53; multiparas: OR: 0.25, 95% CI: 0.20–0.32). Fetal distress was less frequently diagnosed in the modified birth center group (primiparas: OR: 0.72, 95% CI: 0.59–0.87; multiparas: OR: 0.45, 95% CI: 0.29–0.69), but no statistically significant differences were found in neonatal hypoxia, low Apgar score less than 7 at 5 minutes, or proportion of perinatal deaths (OR: 0.40, 95% CI: 0.14–1.13). Anal sphincter tears were reduced (primiparas: OR: 0.73, 95% CI: 0.55–0.98; multiparas: OR: 0.41, 95% CI: 0.20–0.83).

Conclusion:  Midwife-led comprehensive care with the same medical guidelines as in standard care reduced medical interventions without jeopardizing maternal and infant health. (BIRTH 38:2 June 2011)

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