Well women birth better in primary level care, study says
A Christchurch study just published in the prestigious BMJ Open (a subsidiary of the British Medical Journal), has found
that low risk women who choose to give birth in primary-level maternity units have better outcomes than those who choose
hospital environments.
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 supported midwife-led, primary-level maternity units as physically safe places for well women
to plan to give birth. These women had higher rates of natural birthing than those low risk pregnancy women who planned
a tertiary hospital birth, and lower interventions.
Ara midwifery academics Rea Daellenbach and 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 study was led by Christchurch midwife Celia Grigg and included three researchers from different universities in
Sydney, Australia.
“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,’ Mary Kensington said.
This 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.
“The results can give women with low risk pregnancies confidence in planning to give birth in a midwife-led primary
birthing unit and in the New Zealand maternity system,” Rea Daellenbach said.
The study was conducted in Christchurch because of the high number of primary-level maternity units. New Zealand has 54
freestanding midwife-led Primary Maternity Units (PMUs) altogether. The country has 18 secondary-level and six
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 pregnancy through to
outcomes, rather than commencing from the women’s labour. The researchers acknowledged that the Christchurch earthquakes
may have impacted on the study.
A larger nationwide study using this design would be valuable to provide stronger evidence for these results, the
researchers said.
ENDS