Birth centres in Australia: safety, relevance and sustainability
In Australia, 2% of births occur in midwifery-led ‘birth centres’. Place of birth has been shown to impact safety of mothers and babies and is therefore an important public health issue. Research to date has presented methodological challenges and few large studies have examined morbidity and mortality. The purpose of this research is to assess the safety, relevance and sustainability of birth centre care for women and their babies in Australia. Three major studies were undertaken to inform health services policy and practice. Study 1 was a national survey of current characteristics and practices. A definition of a birth centre was developed and types identified. The current situation was compared to a previous study conducted ten years earlier, and showed birth centres to be more varied in terms of interventions and equipment available, but less common. Study 2 examined outcomes by intended place of birth using the National Perinatal Data Collection. It showed that most baby outcomes did not differ between the birth centre and a low-risk, term hospital comparison group. This study demonstrated limitations of national data, particularly regarding the availability and quality of data on maternal risk factors and morbidity. Study 3, using linked health data for New South Wales, is the first comprehensive, population-based study conducted in Australia to examine serious maternal and perinatal morbidity and mortality according to intended place of birth. The Study used a matched-pairs design to control more accurately for differences between women giving birth in birth centres and co-located labour wards. Results showed that maternal and perinatal morbidity and mortality did not significantly differ between the groups, or were significantly different in favour of birth centres: PPH (8.6% vs 10.6%), postpartum infection (1.0% vs 1.4%), admission to NICU/SCN (5.6% vs 8.3%), perinatal mortality (1.05 vs 1.44 per 1,000). These studies provide evidence that birth centres with existing inclusion criteria for labour and childbirth are a viable and safe model of care for women giving birth in Australia. Therefore, birth centre care should either be made available to more women, or other, more accessible and sustainable, models of midwifery care should be expanded.
Australia, Birth, Centre, Midwifery, Morbidity, Outcomes
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