Abstract
Background
For healthy women entering birth after uneventful pregnancy, midwife-led models of care have the potential to reduce interventions and increase the vaginal birth rate. In Germany, 98.4% of women are giving birth in consultant-led obstetric units. Alongside midwifery units (AMU) have been established in 2003. We compared the maternal and perinatal outcome of women registered for planned birth in the AMU at our hospital with a matched group of low-risk women who gave birth in standard obstetric care during the same period of time.
Methods
We used a retrospective cohort study design. The study group consisted of all women admitted to labor ward who had registered for birth in AMU from 2010 to 2017. For the control group, low-risk women were selected; additionally, matching was performed for parity. Mode of birth was chosen as primary outcome parameter for the mother. For the neonate, a composite primary outcome (5-minute Apgar <7 or umbilical cord arterial pH < 7.10 or transfer to specialist neonatal care) was defined. Secondary outcomes included epidural anesthesia, duration of the second stage of labor, episiotomy, obstetric injury, and postpartum hemorrhage. Non-inferiority was assessed, and multiple logistic regression analysis was performed.
Results
612 women were admitted for labor in AMU, the control group consisted of 612 women giving birth in standard obstetric care. Women in the study group were on average older and had a higher BMI. Birthweight was on average 95 g higher in the study group. Non-inferiority could be established for the primary outcome parameters. In the study group, less interventions were performed (epidural anesthesia rate 19.1% vs. 41.2%; episiotomy rate 4.7% vs. 8.6%). The duration of the second stage of labor was shorter (47.4 min. vs. 55.6 min.), and second-degree perineal tears were less common in the study group (34.4% vs. 46.4%), higher-order obstetric lacerations occurred more frequently in the study group (2.3% vs. 0.9%). There was no difference in the postpartum hemorrhage rate.
Maternal and neonatal outcome of births planned in alongside midwifery units: A cohort study from a tertiary center in Germany
