Christchurch researchers, in collaboration with the University of Sydney, have completed a world-first study showing the safety of primary birthing units for healthy expectant mothers.
When Melissa O’Grady visited Lincoln’s Primary Maternity Unit on an antenatal visit, she felt immediately at home. “It was calm, welcoming and the midwives were wonderful and warm.”
That positive first impression convinced the 30-year-old Burnham woman that a Primary Maternity Unit (PMU) was the perfect place to have her first baby.
Her determination to have her baby in a non-clinical environment was such that when her waters broke while visiting her grandmother at Christchurch Hospital, she hopped in her car and drove home to avoid well-meaning attempts to admit her to the neighbouring Christchurch Women’s Hospital. Baby Joseph Roguski was born without complications a few hours later at the Lincoln unit; a healthy 3.2 kilograms.
Joe and his mother stayed at Lincoln for three nights. Joe’s father and his maternal grandmother also stayed a few nights – making it a “wonderful experience” for the wider family. In the weeks since his birth, Joe has thrived. “He’s such a good baby. He sleeps well and feeds well, and my mother reckons it’s partly because he was born in such a nice, homely environment, not in a more clinical one,” O’Grady says.
She is in the minority having her baby at a PMU, as most New Zealand women choose to give birth in hospital. In 2015, 86.4% of New Zealand births occurred in a secondary or tertiary hospital, 9.9% in a freestanding PMU and 3.4% were home births.
Primary-level maternity units offer birthing facilities with midwifery services, while tertiary and secondary-level units offer midwifery services, specialist obstetric, anaesthetic and paediatric services.
O’Grady is pleased she bucked the trend and recommends all her pregnant friends consider that option.
Research from Ara Institute of Canterbury, published in the BMJ Open (a subsidiary of the British Medical Journal) shows that if mothers choose a PMU, they and their babies will be as safe as if they gave birth in a hospital. In fact, the study of almost 700 Canterbury women found low risk women who chose to give birth at primary-level maternity units had better outcomes than those who chose hospital environments.
LOCATION OF NEW ZEALAND BIRTHS
86.4 % Secondary or Tertiary Hospital
9.9 % Freestanding PMU
3.4 % Home Births
Ara maternity researcher Rea Daellenbach says the study demonstrates that midwife-led, primary-level maternity units are physically safe places for well women to give birth. Women who give birth at a primary unit are also more likely to have a natural birth and fewer interventions, such as forceps delivery, than those who have a hospital birth. The study found no difference between the health of babies delivered at Christchurch Women’s Hospital or a PMU.
The study was a collaboration between Ara academics and researchers from the University of Sydney. Daellenbach and her colleagues were invited to be part of the Australian-funded research because of their strong academic credentials, and Christchurch’s range of birthing options.
“We’re pretty lucky in Christchurch because women have choices. There’s three excellent primary units, plus Christchurch Women’s. This choice is not the norm in Australia or all parts of New Zealand.”
New Zealand has 54 freestanding midwife-led Primary Maternity Units (PMUs). There are 18 secondary-level and six tertiary-level obstetric-led maternity hospitals or Tertiary Medical Units (TMHs), with specialist services.
The study was a world-first because it examined where women planned to give birth, and why. About half of women who planned to give birth at a primary unit actually had their babies in the hospital, with 17% of them transferring during labour to Christchurch Women’s Hospital. However, overall the women who initially planned to go to a primary unit still had better outcomes than the low risk women who planned a hospital birth. It is worth noting that a third of the women who wanted to birth at a primary unit but transferred to Christchurch Women’s did so because of earthquake disruptions to PMUs.
Researchers found a woman’s confidence in themselves and their ability to give birth was a common factor for those who chose a primary level birth. “These women were confident in their own ability to give birth naturally, and confident that the maternity system would support them. Confidence is quite a different concept from trust. It’s more personal to the woman and way more empowering. They are saying they believe in themselves and that is very powerful,” says Daellenbach.
The study would have included more women but the earthquakes disrupted recruitment for the study.
Daellenbach says she and the other researchers are grateful to those who agreed to take part, as their birth stories provide much needed information for other expectant mothers. “The results can give women with low risk pregnancies confidence in planning to give birth in a midwife-led primary birthing unit and in the New Zealand maternity system.”