[Planned location for delivery; no relationship with maternal or neonatal morbidity]

Abstract

Objective: To compare maternal and neonatal outcomes of planned primary-care birth-centre deliveries with those of planned home deliveries and planned outpatient deliveries.

Design: Retrospective cohort study.

Method: We used data collected in the period February 2009 to November 2013 from 4 community midwife practices attached to the Sophia birth centre (GCS), which is attached to the Erasmus MC academic hospital in Rotterdam, The Netherlands. We included women with low-risk pregnancies for whom primary-care midwives were responsible at the start of the delivery. Pregnant women were stratified according to planned location of delivery (home, outpatient or GCS). The most important outcome measures were: medical intervention during the delivery, and maternal or neonatal morbidity. We used 'propensity score matching' to correct for confounding factors.

Results: We included a total of 6185 pregnant women in our study. After propensity score matching, no statistically significant difference was seen in the total number of medical interventions during pregnancy, total maternal morbidity and total neonatal morbidity between pregnant women with planned home deliveries and those with planned GCS deliveries. (Medical interventions 13.6% and 12.4%, respectively; p-value 0.56. Maternal morbidity 4.9% and 5.7%, respectively; p-value 0.53. Neonatal morbidity 6.8% and 5.4%, respectively; p-value 0.31.) Similar results were seen when we compared pregnant women with planned outpatient deliveries with pregnant women with planned deliveries in the GCS.

Conclusion: In women with low-risk pregnancies the planned location for delivery does not seem to be related to either the number of medical interventions during pregnancy or to maternal or neonatal morbidity. The GCS seems, therefore, to be an appropriate location for these women to deliver, but this should be confirmed by further studies.