Local birthing services for rural women: Adaptation of a rural New South Wales maternity service.
Michelle Durst, Margaret Rolfe, Jo Longman and 5 others
PMID 27381020WHAT IT FOUND
In the midwife-led low-risk group, women had no inductions and almost all vaginal births, less analgesia, and broadly similar neonatal outcomes.
First-degree tears were more common. The service also added a planned caesarean service, and midwife-led birth numbers nearly halved.
Key findings
01In the midwife-led group, almost all women had a normal vaginal birth, there were no inductions, and one caesarean birth was performed by a visiting obstetrician.
02Midwife-led births used less analgesia than GPO births: 45.3% had none versus 25.1%, and 4.9% had both invasive and non-invasive analgesia versus 26.7%; first-degree tears were 22.6% versus 15.4% and episiotomies were 1.9% versus 3.4%.
03Neonatal outcomes were broadly similar: no difference in 5-minute Apgar scores, resuscitation or level 3 or higher special care transfers, although onsite Level 2 admissions were 5 versus 1.
STILL TO COME
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What it does not show
This was a before-and-after service evaluation, not a randomised comparison, so differences cannot be assigned to the midwife-led model alone; the service also added a planned caesarean service, changed risk screening, and operated in a context of staff resignations and community opposition. The groups had different casemixes: the MGP service screened women as low risk, while the PCS group had different maternal characteristics, so direct comparison between GPO and MGP/PCS was not possible. The register did not include women who received antenatal or postnatal care at the district hospital but gave birth elsewhere because of intrapartum risk, and transfer data were unavailable, so outcomes for transferred women were not assessed. The study was too small to comment on less common neonatal and obstetric safety outcomes. Data came from a handwritten register with missing or inconsistent entries, and missing data were excluded from percentage calculations.
Declared interests
The authors declared no competing interests.
The easy way to misread this
Do not read the very low induction and caesarean rates in the midwife-led group as proof that midwife-led care alone improves outcomes. The service change also added a planned caesarean service, changed low-risk screening and casemix, and the study did not include transferred births, so the contribution of any single component cannot be separated.