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

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.