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Cited by 104Maternal and Perinatal Health InterventionsMaternal and Neonatal HealthcareInfant Development and Preterm Care

The Stockholm Birth Centre Trial: maternal and infant outcome

Waldenstrom, Ulla, Nilsson, Carl‐Axel, Winbladh, Birger·1997·BJOG: An International Journal of Obstetrics & Gynaecology
DOI 10.1111/j.1471-0528.1997.tb11491.x
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Abstract

Objective To compare an in‐hospital birth centre with standard maternity care regarding medical interventions and maternal and infant outcome. Background The birth centre care was characterised by comprehensive antenatal, intrapartum and postpartum care with the same team of midwives, restricted use of medical technology, and discharge within 24 h after birth. Methods Of 1860 women meeting low risk medical criteria in early pregnancy and interested in birth centre care, 928 were randomly allotted birth centre care and 932 standard maternity care. Data were collected mainly from hospital records, and analysis was by intention‐to‐treat. Results Of the women in the birth centre group, 13% were transferred antenatally and 19% intrapartum. No statistical differences were observed in maternal morbidity or in perinatal mortality, neonatal morbidity, Apgar score or infant admissions to neonatal care. Perinatal mortality, defined as intrauterine death after 22 weeks of gestation and infant death within seven days of birth, occurred in eight cases (0.9%) in the birth centre group and in two cases (0.2%) in the standard care group (OR 4.04, 95% CI 0.80 to 39.17; P= 0.11). Subgroup analysis showed that a larger proportion of first‐born babies in the birth centre group (15.6%) were admitted for neonatal care than in the standard care group (9.5%) (P= 0.003), whereas the converse was the case for the newborns of multiparous women: 4.7% and 8.4%, respectively (P= 0.04). The overall rates of operative delivery (e.g. caesarean section, vacuum extraction and forceps), 11.1% in the birth centre group and 13.4% in the standard care group, did not differ statistically (P= 0.12), but obstetric analgesia, induction, augmentation of labour and electronic fetal monitoring were less frequently used in the birth centre group. Labour was 1 h longer in the birth centre group. Conclusion Birth centre care was associated with less medical interventions than standard care without any statistically significant differences in health outcomes. However, the excess of perinatal deaths and of morbidity in primigravidas’ infants in the birth centre group gives cause for concern and necessitates further studies.

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Crossref · 10.1111/j.1471-0528.1997.tb11491.x

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Authors
Waldenstrom, U., Nilsson, C., & Winbladh, B.
Affiliations
  • Swedish Institute for Health Services Development (SE)
  • Sachs' Children and Youth Hospital (SE)
Venue
BJOG: An International Journal of Obstetrics & Gynaecology
Publisher
Wiley
Published
1997-04
Volume
104
Issue
4
Pages
410-418
ISSN
  • 0306-5456 (ISSN-L)
  • 1470-0328
  • 1471-0528
DOI
10.1111/j.1471-0528.1997.tb11491.x
OpenAlex
W2092772121
Cited by
104
References
17
Citations by year
2024: 1 · 2020: 2 · 2018: 2 · 2017: 5 · 2016: 5 · 2015: 2 · 2014: 2 · 2013: 5 · 2012: 10
FWCI
7.23
Type
journal article
Language
en
Open access
closed
Licence
onlinelibrary.wiley.com/termsAndConditions#vor (vor, 3062 d)
Locations
  • BJOG An International Journal of Obstetrics & Gynaecology (publishedVersion)
  • PubMed (publishedVersion)
Topics
  • Health Sciences › Medicine › Obstetrics and Gynecology › Maternal and Perinatal Health Interventions
  • Health Sciences › Health Professions › General Health Professions › Maternal and Neonatal Healthcare
  • Health Sciences › Medicine › Pediatrics, Perinatology and Child Health › Infant Development and Preterm Care
Keywords
perinatal mortality, neonatal morbidity, instrumental delivery, obstetric analgesia, labor induction, fetal heart rate monitoring, primiparous women, low-risk pregnancy, midwifery care, childbirth interventions, labour duration, neonatal intensive care admission, Apgar score
MeSH terms
Adult, Apgar Score, Birth Weight, Female, Humans, Infant, Infant Mortality, Infant, Newborn, Labor, Obstetric, Length of Stay, Parity, Patient Transfer, Postnatal Care, Pregnancy, Pregnancy Complications, Pregnancy Outcome, Prenatal Care, Sweden, Birthing Centers, Perinatal Care

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