Birth centre care : reproduction and infant health

Abstract

This thesis has two general aims, to investigate factors affecting women s decision to have a second baby and to study the effect of birth centre care on infant outcome. The specific aims were to investigate 1) whether birth centre care during a woman s first pregnancy had an effect on her future reproduction, 2) whether a negative experience of the first birth had en effect on future reproduction, and 3) whether birth centre care had an effect on perinatal mortality 4) and on morbidity during the infant s first month.

Nulliparous women randomly allocated to in-hospital birth centre care (n=505) and to standard maternity care (n=479) in early pregnancy were followed during a period of 7-10 years after the birth. Information about a second birth was collected from the Swedish Medical Birth Register and analysed by the Kaplan Meier method. No statistically significant differences were found between the groups in terms of having a second baby and the time to second birth (median: 2.85 versus 2.82 years, log-rank 1.26; p=0.26).

Experience of childbirth was assessed in 617 first-time mothers. Information relating women s global assessment of the birth experience (questionnaire two months postpartum) and various background variables (questionnaire in early pregnancy) was linked to the Swedish Medical Birth Register. Women with a negative experience had fewer subsequent children and a longer interval to the second baby. 38% of women with a negative experience did not have another baby during the following 8 10 years, compared with 17% of those with a less negative experience (p<0.001).

Two studies investigated perinatal mortality and infant morbidity in all women (n=3256) admitted to an in-hospital birth centre from 1989 to 1999. Data were compared with the outcomes for all the other women in the Greater Stockholm who gave birth in standard care during the same period and who met the same medical low-risk criteria as in the birth centre group (n=180 380). Outcome data were collected from the Swedish Medical Birth Register, the Swedish Hospital Discharge Register and medical records. Logistic regression analyses were performed to control for potential confounding background factors.

No statistically significant difference in the overall perinatal mortality rate was found between the birth centre group and the standard care group (OR 1.5; 0.9 2.4), but the infants of primiparas were at higher risk in the birth centre group (OR 2.2; 1.3 3.9). Infants in the birth centre group had a higher risk of respiratory problems (OR 1.5; 1.2 1.8) and a lower risk of clavicle and other fractures (OR 0.4; 0.3 0.6).

In conclusion, birth centre care during a woman s first pregnancy does not appear to affect future reproduction, but a negative overall childbirth experience does. Birth centre care might be associated with a higher risk of perinatal mortality in first-born babies, minor respiratory problems and a lower risk of birth trauma such as fractures. It is important to consider maternal and infant risk factors in the planning of models for childbirth care.