Midwife Centres As Safe As Hospital: Study

Midwife centres as safe as hospitals, says study

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Ruth Pollard
September 3, 2007

BABIES born in midwife-run birth centres had significantly lower death rates than those born in hospitals, an Australian study of more than 1 million births has found.

Contradicting claims from doctors' groups that birth centres increased the risk of the baby dying, the study of all births in Australia from 1999 until 2002 confirmed the centres provide care that is as safe, if not safer, as standard maternity units.

"This study clearly shows that claims that Australian birth centres are dangerous are simply wrong," said Barbara Vernon, the executive officer of the Australian College of Midwives. "Governments should immediately expand women's access to primary midwifery-led care with medical back-up … the safety and efficacy of birth centres is beyond doubt."

The birth centres in the study were located alongside or in hospitals, and were run by midwives but with medical back-up close by.

"In birth centres, women can labour normally, they can move around … and they have more intensive support during pregnancy so they are more confident during labour," Dr Vernon said.

Yet in labour wards, medical interventions used to help women give birth, such as artificially starting or accelerating labour and the use of epidurals and anaesthesia, increased the risk to the baby, Dr Vernon said.

Sally Tracy, a professor of midwifery at the University of Technology, Sydney, and lead author of the study, said it showed babies were no more likely to die in a birth centre than in a labour ward.

"That has been what the Australian Medical Association and the National Association of Specialist Obstetricians and Gynaecologists have been saying - that women are stupid to give birth in the birth centre, their babies will die - and this study proves this is not the case."

Examining all peri-natal deaths over a four-year period, the study found the peri-natal death rate for babies born to first-time mothers in a birth centre was 1.4 per 1000 compared with 1.9 per 1000 for similar low-risk babies born in hospital labour wards.

For mothers of subsequent babies, the rates were 0.6 per 1000 for birth centre babies compared with 1.6 per 1000 for hospital-born babies, Professor Tracy said.

Of the more than 1 million births in Australia over those four years, 21,800 took place in birth centres next to or within hospitals. However, differences between the way states and territories recorded the transfer of a woman from a birth centre to a labour ward placed some limitations on the data, she said.

The findings should reassure women who have a normal pregnancy that they will have good outcomes whether they chose a birth centre or hospital-based care, said Andrew Pesce, the chairman of the National Association of Specialist Obstetricians and Gynaecologists.

However Dr Pesce said Professor Tracy's study was limited by "a failure to know how many women with problems had been transferred out of the birth centre and to a labour ward to give birth". He called on midwives and obstetricians to work together, rejecting the idea of segregating midwife-only care from what he described as "the more conventional model".

Petra Smedley had both her children - three-week-old Romy and three-year-old Tristan - in the birth centre at Royal Prince Alfred Hospital. So positive was her experience that she is encouraging her friends to do the same. "I always felt very safe [at the centre]," Mrs Smedley, 38, said.

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Scary isn't it, when they talk like that... and talk to women who think they know best.

This was actually on the Today Show this morning....I am glad there is evidence now to show that birth centres are safe and provide good outcomes for mothers and babies. We just need more of them!

Yep it was on Today:

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Childbirth options
Tuesday September 4, 2007

A new Australian study has revealed babies born in midwife run birthing centres have lower death rates when compared with those born in traditional hospitals.

Midwifery researcher Hannah Dahlen joins TODAY to discuss the results of the study.

"The study was done from 1999 until 2002 and it confirmed the centres provide safe care, if not safer than standard maternity units," explains Ms Dahlen. "Babies born in birth centres had a lower death rate than those born in hospitals according to a new Australian study of more than 1 million births."


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The research paper is called 'Birth Centres in Australia: A national population-based study of prenatal mortality associated with giving birth in a birth centre.' "It has just been published in one of the leading Journals in the world called 'Birth'," she says.

"The study is about the safety of having a baby in a birth centre in Australia," she says. "We looked at four years of births in Australia (over one million) of which 21,800 gave birth in a birth centre."

"The conclusion is that women who are low risk can give birth in a birth centre knowing it is as safe if not safer than a delivery ward," reveals Ms Dahlen.

Birth centres are staffed and run by midwives and offer care to women with uncomplicated pregnancies. "The centres have a philosophy of supporting normal birth with the least intervention possible," according to Ms Dahlen. "They use water and massage and gas mostly for pain relief and women can be transferred to the delivery ward if they need an epidural."

"In Australia the centres are usually located in a hospital so if there are any complications a doctor is called or they are transferred to the delivery ward for medical assessment."

"Ultimately, birth centres are midwife run and doctors only come in them when asked due to a problem," explains Ms Dahlen. "Low intervention rates mean that women are mainly encouraged to be mobile during labour, not stuck on a bed hooked up to a machine and use natural methods of pain relief to help prevent complications."

"We have known for some time that birth centres lead to more normal birth and fewer dangerous medical interventions with higher satisfaction and higher rates of breastfeeding," she says, "but now we can say they also are very safe for mothers and babies."

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Making me feel better every day about my choice to have bub # 2 in a birth centre......

This is the most important bit, because it shows that for similar low-risk deliveries, birth centres have the edge:

"Examining all peri-natal deaths over a four-year period, the study found the peri-natal death rate for babies born to first-time mothers in a birth centre was 1.4 per 1000 compared with 1.9 per 1000 for similar low-risk babies born in hospital labour wards.

For mothers of subsequent babies, the rates were 0.6 per 1000 for birth centre babies compared with 1.6 per 1000 for hospital-born babies, Professor Tracy said."

Since Australian birth centres are located in or alongside hospitals, how much safer can they be??? At the John Hunter in Newcastle, the birth centre is actually within Delivery Suite. The registrars, consultants, operating theatre and NICU are within metres.