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What evidence supports the use of free-standing midwifery led units (primary units) in New Zealand/Aotearoa?

Abstract:

Background: Free-standing midwifery led units (FMLUs) (known in New Zealand as a primary maternity unit), provide midwifery led care for low-risk women in local, family friendly environments which are generally some distance from an obstetric unit (OU) (known in New Zealand as a secondary or tertiary facility). The majority of women in New Zealand/ Aotearoa choose to give birth in an OU and reasons for this choice may be related to safety concerns. Aim: To identify, compare and critically evaluate published studies on FMLUs to determine the evidence that contributes to safety and may be useful for the New Zealand/Aotearoa maternity context. Method: Five databases were searched using the search terms: place of birth, midwife-led, primary unit, maternal outcomes, neonatal outcomes. The primary outcome of interest was place of birth and the impact on mortality or morbidity rates for maternal and neonatal health. Secondary outcome measures were intervention rates during labour. Findings: Three studies were found which compared maternal and neonatal outcomes for low risk women planning to birth in free standing midwifery led units or obstetric units. These studies found less augmentation during labour and higher rates of normal birth in FMLUs. Low-risk women who planned to birth in an OU had higher rates of epidural anaesthesia, instrumental birth, cesarean section and episiotomy rates. Neonatal health appeared to benefit with no differences in mortality rates but higher Apgar scores at 5 minutes and lower rates of admission to a neonatal intensive care unit for babies when birth was planned at a FMLU. Conclusion: There is strong and consistent evidence to support FMLU birth as a safe option for women experiencing a low-risk pregnancy.

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Free standing midwifery led units, maternal outcomes, midwife-led, neonatal outcomes, primary unit