Well women birth better in primary level units

12 September 2017
Mother and newborn baby

A Christchurch study has found that low-risk women who choose to give birth in primary-level maternity units have better outcomes than those who choose hospital care.

The Ara Institute study, published in the journal BMJ Open, supported midwife-led care at primary-level maternity units as physically safe for well women to plan to give birth.

Primary-level maternity units (PMUs) offer birthing facilities with midwifery services, while tertiary and secondary-level units offer midwifery services, specialist obstetric, anaesthetic and paediatric services.

The results of the study found that well women who planned to give birth in primary-level units had higher rates of natural birthing than those low risk pregnancy women who had a tertiary hospital birth, and lower interventions.

Ara Institute midwifery academics Mary Kensington were part of the Trans-Tasman research team for the study.  and resulting paper: Evaluating Maternity Units: a prospective cohort study of freestanding midwife-led primary maternity units in New Zealand—clinical outcomes.

The Ara Institute study was led by Christchurch midwife Celia Grigg says the results should give women confidence in midwife-led primary birthing units.

“Many people believe birth is only normal in retrospect and that women should have their babies in an obstetric led hospital.

“However, this research complements other research on place of birth which shows that women who are low risk are better off utilising a midwife led primary birth facility,’ Ms Kensington says.

The study examined outcomes for women who planned to give birth in the immediate Christchurch area, in either Christchurch Women’s Hospital or in one of the primary units.

The data was analysed by where women had planned to birth. Some women who planned to birth at a primary unit actually had their babies in the hospital.

However, overall the women who initially planned to go to a primary unit still had better outcomes than the low risk women who had planned a hospital birth.

New Zealand has 54 freestanding midwife-led Primary Maternity Units (PMUs). The country has 18 secondary-level and 6 tertiary-level obstetric-led maternity hospitals or Tertiary Medical Units (TMHs), with specialist services.

Most women still chose to birth in hospital. In 2015, 86.4% of New Zealand births occurred in a secondary or tertiary hospital, 9.9% in a freestanding PMU and 3.4% were home births.

The study is the first of its kind in New Zealand to follow women from their planned place of birth through to outcomes.

A larger nationwide study using this design would be valuable to provide stronger evidence for these results, the researchers said.

You can read the full study comparing birth outcomes at primary level birthing units and tertiary units here.