Self-rated ‘no’ and ‘low’ risk pregnancy: a comparison of outcomes for women in obstetric-led and midwife-led units in England

Andrew G. Symon, Jeanette Paul, M. Butchart, Val Carr, Pat Dugard

    Research output: Contribution to journalArticle

    7 Citations (Scopus)

    Abstract

    Background: Debate in the United Kingdom about place of birth often concerns obstetric-led units and midwife-led units and relates to notions of risk and safety. Outcomes for these two types of unit are often not comparable because of the restricted selection criteria for midwife-led units. The purpose of this study was to compare outcomes for women intending to give birth in these different types of unit and whose self-rated pregnancy risk level was “none” or “low.” Methods: Self-completion questionnaires were distributed to mothers 8 days after the birth in 9 units (6 midwife led 3 obstetric led) over a 6-month period.Results: Completed questionnaires were received from 432 women (midwife led = 294, obstetric led = 138). Mothers in midwife-led units spent shorter times in labor in the unit (p < 0.01), received less analgesia (p < 0.01) and had fewer interventions (p < 0.01), and were more likely to have a normal delivery (p < 0.01) than women in obstetric-led units. Similar differences were found for both primiparous and multiparous women. In terms of the number of midwives attending each woman, analysis of covariance suggested different models of care depending on type of unit (p < 0.05) and parity (p < 0.01).Conclusions: Since these mothers’ self-rated risk level was none or low, some comparability of outcomes is permissible. It appears that models of care are significantly different in obstetric-led units compared with midwife-led units, leading to greater likelihood of intrapartum intervention, need for analgesia, and assisted or operative delivery. A randomized controlled trial examining such units would permit a conclusive examination of these outcomes.
    Original languageEnglish
    Pages (from-to)323-330
    Number of pages8
    JournalBirth
    Volume34
    Issue number4
    DOIs
    Publication statusPublished - 2007

    Fingerprint

    Midwifery
    England
    Obstetrics
    Pregnancy
    Mothers
    Analgesia
    Parturition
    Parity
    Patient Selection
    Randomized Controlled Trials
    Safety

    Keywords

    • Midwife-led unit
    • Obstetric-led unit
    • Risk level
    • Outcomes
    • Model of care

    Cite this

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    title = "Self-rated ‘no’ and ‘low’ risk pregnancy: a comparison of outcomes for women in obstetric-led and midwife-led units in England",
    abstract = "Background: Debate in the United Kingdom about place of birth often concerns obstetric-led units and midwife-led units and relates to notions of risk and safety. Outcomes for these two types of unit are often not comparable because of the restricted selection criteria for midwife-led units. The purpose of this study was to compare outcomes for women intending to give birth in these different types of unit and whose self-rated pregnancy risk level was “none” or “low.” Methods: Self-completion questionnaires were distributed to mothers 8 days after the birth in 9 units (6 midwife led 3 obstetric led) over a 6-month period.Results: Completed questionnaires were received from 432 women (midwife led = 294, obstetric led = 138). Mothers in midwife-led units spent shorter times in labor in the unit (p < 0.01), received less analgesia (p < 0.01) and had fewer interventions (p < 0.01), and were more likely to have a normal delivery (p < 0.01) than women in obstetric-led units. Similar differences were found for both primiparous and multiparous women. In terms of the number of midwives attending each woman, analysis of covariance suggested different models of care depending on type of unit (p < 0.05) and parity (p < 0.01).Conclusions: Since these mothers’ self-rated risk level was none or low, some comparability of outcomes is permissible. It appears that models of care are significantly different in obstetric-led units compared with midwife-led units, leading to greater likelihood of intrapartum intervention, need for analgesia, and assisted or operative delivery. A randomized controlled trial examining such units would permit a conclusive examination of these outcomes.",
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    author = "Symon, {Andrew G.} and Jeanette Paul and M. Butchart and Val Carr and Pat Dugard",
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    Self-rated ‘no’ and ‘low’ risk pregnancy : a comparison of outcomes for women in obstetric-led and midwife-led units in England. / Symon, Andrew G.; Paul, Jeanette; Butchart, M.; Carr, Val; Dugard, Pat.

    In: Birth, Vol. 34, No. 4, 2007, p. 323-330.

    Research output: Contribution to journalArticle

    TY - JOUR

    T1 - Self-rated ‘no’ and ‘low’ risk pregnancy

    T2 - a comparison of outcomes for women in obstetric-led and midwife-led units in England

    AU - Symon, Andrew G.

    AU - Paul, Jeanette

    AU - Butchart, M.

    AU - Carr, Val

    AU - Dugard, Pat

    N1 - dc.publisher: Wiley

    PY - 2007

    Y1 - 2007

    N2 - Background: Debate in the United Kingdom about place of birth often concerns obstetric-led units and midwife-led units and relates to notions of risk and safety. Outcomes for these two types of unit are often not comparable because of the restricted selection criteria for midwife-led units. The purpose of this study was to compare outcomes for women intending to give birth in these different types of unit and whose self-rated pregnancy risk level was “none” or “low.” Methods: Self-completion questionnaires were distributed to mothers 8 days after the birth in 9 units (6 midwife led 3 obstetric led) over a 6-month period.Results: Completed questionnaires were received from 432 women (midwife led = 294, obstetric led = 138). Mothers in midwife-led units spent shorter times in labor in the unit (p < 0.01), received less analgesia (p < 0.01) and had fewer interventions (p < 0.01), and were more likely to have a normal delivery (p < 0.01) than women in obstetric-led units. Similar differences were found for both primiparous and multiparous women. In terms of the number of midwives attending each woman, analysis of covariance suggested different models of care depending on type of unit (p < 0.05) and parity (p < 0.01).Conclusions: Since these mothers’ self-rated risk level was none or low, some comparability of outcomes is permissible. It appears that models of care are significantly different in obstetric-led units compared with midwife-led units, leading to greater likelihood of intrapartum intervention, need for analgesia, and assisted or operative delivery. A randomized controlled trial examining such units would permit a conclusive examination of these outcomes.

    AB - Background: Debate in the United Kingdom about place of birth often concerns obstetric-led units and midwife-led units and relates to notions of risk and safety. Outcomes for these two types of unit are often not comparable because of the restricted selection criteria for midwife-led units. The purpose of this study was to compare outcomes for women intending to give birth in these different types of unit and whose self-rated pregnancy risk level was “none” or “low.” Methods: Self-completion questionnaires were distributed to mothers 8 days after the birth in 9 units (6 midwife led 3 obstetric led) over a 6-month period.Results: Completed questionnaires were received from 432 women (midwife led = 294, obstetric led = 138). Mothers in midwife-led units spent shorter times in labor in the unit (p < 0.01), received less analgesia (p < 0.01) and had fewer interventions (p < 0.01), and were more likely to have a normal delivery (p < 0.01) than women in obstetric-led units. Similar differences were found for both primiparous and multiparous women. In terms of the number of midwives attending each woman, analysis of covariance suggested different models of care depending on type of unit (p < 0.05) and parity (p < 0.01).Conclusions: Since these mothers’ self-rated risk level was none or low, some comparability of outcomes is permissible. It appears that models of care are significantly different in obstetric-led units compared with midwife-led units, leading to greater likelihood of intrapartum intervention, need for analgesia, and assisted or operative delivery. A randomized controlled trial examining such units would permit a conclusive examination of these outcomes.

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    KW - Obstetric-led unit

    KW - Risk level

    KW - Outcomes

    KW - Model of care

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    DO - 10.1111/j.1523-536X.2007.00191.x

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    JO - Birth

    JF - Birth

    SN - 0730-7659

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    ER -