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Safety of birth centre care: perinatal mortality over a 10-year period
Karin Gottvall1, Charlotta Grunewald, Ulla Waldenström
1Department of Nursing, Karolinska Institutet, Huddinge, Sweden.
Objective:
To study perinatal mortality in women booked for birth centre care during pregnancy.
Design:
Retrospective cohort study.
Setting:
In-hospital birth centre and standard maternity care in Stockholm.
Population:
Two thousand and five hundred and thirty-four women (3256 pregnancies) admitted to an in-hospital birth centre over 10 years (1989-2000) and 126818 women (180380 pregnancies) who gave birth in standard care during the same period and who met the same medical inclusion criteria as in the birth centre. Multiple pregnancies were excluded.
Methods:
Data were collected from the Swedish Medical Birth Register. Information on all cases of perinatal death in the birth centre group was retrieved from the medical records.
Main Outcome Measure:
Perinatal mortality.
Results:
No statistically significant difference in the overall perinatal mortality rate was observed between the birth centre group and the standard care group (odds ratio [OR] 1.5, 95% CI 0.9-2.4), but infants of primiparas were at greater risk (OR 2.2, 95% CI 1.3-3.9). Infants of multiparas tended to be at lower risk, but this difference was not statistically significant (OR 0.7, 95% CI 0.3-1.9). These figures were adjusted for maternal age and gestation in multiple regression analyses.
Conclusion:
Birth centre care may be less safe for infants of first-time mothers.