Intrapartum and childbirth care and outcomes in midwife-led birth centres in France: A nationwide descriptive study with an analysis of maternal and neonatal transfers

IF 4.4 2区医学 Q1 NURSING

Women and Birth Pub Date : 2025-04-16 DOI:10.1016/j.wombi.2025.101908

Anne Alice Chantry , Candy Guiguet-Auclair , Clara Rollet , Mayanne Pralus , Marine Dubel-Jam , Ingele Roelens , Mathilde Revolon , Anne Evrard , Sophie Goyet , Camille Le Ray , Priscille Sauvegrain , Françoise Vendittelli , on behalf of the MDN Research Group

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引用次数: 0

Abstract

Problem

Midwife-led birth centres (MLBCs) offer an alternative to obstetric-led units (OUs) for low-risk women. Despite positive assessments, their development still remains controversial.

Aim

To assess the appropriateness of care, intrapartum and childbirth care, and outcomes of women with a planned birth in MLBCs and to describe transfers to OUs and their risk factors.

Methods

This was a 2-year (2018–2019) nationwide population-based retrospective cohort involving women with a planned birth in all eight French MLBCs. We described the appropriateness of care, intrapartum and childbirth care, maternal and neonatal outcomes and causes of transfers to OUs. We calculated adjusted odds ratios to identify risk factors for transfers during labour and after birth.

Results

Among 1313 women with a planned MLBC birth, the appropriateness of care was high, with 99.3 % of women meeting low-risk criteria. Intrapartum care in MLBCs featured few interventions (2.2 % artificial membrane ruptures and 1.1 % episiotomies). Regardless of the final place of birth, there were 90.8 % spontaneous vaginal births, 2.6 % caesarean births, 6.6 % operative vaginal births, 2.4 % severe postpartum haemorrhages, 0.4 % Apgar scores < 7 at 5 min and one neonatal death. Transfers to an OU involved 21 % of women with a planned birth in an MLBC during labour and 5.8 % after birth, mainly due to postpartum haemorrhage; 4.6 % of newborns were transferred, often for monitoring.

Conclusion

With appropriate selection of women and low-intervention care, French MLBCs achieve salutogenic outcomes. We identified risk factors for transfers. Further research is needed to assess safety comprehensively with comparative studies.

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来源期刊

Women and Birth NURSING-OBSTETRICS & GYNECOLOGY

CiteScore

7.20

自引率

13.20%

发文量

371

审稿时长

27 days

期刊介绍： Women and Birth is the official journal of the Australian College of Midwives (ACM). It is a midwifery journal that publishes on all matters that affect women and birth, from pre-conceptual counselling, through pregnancy, birth, and the first six weeks postnatal. All papers accepted will draw from and contribute to the relevant contemporary research, policy and/or theoretical literature. We seek research papers, quality assurances papers (with ethical approval) discussion papers, clinical practice papers, case studies and original literature reviews. Our women-centred focus is inclusive of the family, fetus and newborn, both well and sick, and covers both healthy and complex pregnancies and births. The journal seeks papers that take a woman-centred focus on maternity services, epidemiology, primary health care, reproductive psycho/physiology, midwifery practice, theory, research, education, management and leadership. We also seek relevant papers on maternal mental health and neonatal well-being, natural and complementary therapies, local, national and international policy, management, politics, economics and societal and cultural issues as they affect childbearing women and their families. Topics may include, where appropriate, neonatal care, child and family health, women’s health, related to pregnancy, birth and the postpartum, including lactation. Interprofessional papers relevant to midwifery are welcome. Articles are double blind peer-reviewed, primarily by experts in the field of the submitted work.