Document Detail

Outcomes of free-standing, midwife-led birth centers: a structured review.
MedLine Citation:
PMID:  15330886     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Over the last two decades, childbirth worldwide has been increasingly concentrated in large centralized hospitals, with a parallel trend toward more birth interventions. At the same time in several countries, interest in midwife-led care and free-standing birth centers has steadily increased. The objective of this review is to establish the current evidence base for free-standing, midwife-led birth centers. METHODS: A structured review, based on Cochrane guidelines, was conducted that included nonrandomized studies. The comparative outcomes measured were rates of normal vaginal birth; cesarean section; intact perineum; episiotomy; transfers; and babies remaining with their mothers. RESULTS: Of the 5 controlled studies that met the review criteria, all except one was a single site study. Since no study was randomized, meta-analysis was not performed. The included studies all raised quality concerns, and significant heterogeneity was observed among them. For the outcomes measured, every study reported a benefit for women intending to give birth in the free-standing, midwife-led unit. CONCLUSIONS: The benefits shown for women recruited into the included studies who intended to give birth in a free-standing, midwife-led unit suggest a question about the efficacy of consultant unit care for low-risk women. However, the findings cannot be generalized beyond the individual studies. Good quality controlled studies are needed to investigate these issues in the future.
Denis Walsh; Soo M Downe
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't; Review    
Journal Detail:
Title:  Birth (Berkeley, Calif.)     Volume:  31     ISSN:  0730-7659     ISO Abbreviation:  Birth     Publication Date:  2004 Sep 
Date Detail:
Created Date:  2004-08-27     Completed Date:  2004-12-02     Revised Date:  2006-11-15    
Medline Journal Info:
Nlm Unique ID:  8302042     Medline TA:  Birth     Country:  United States    
Other Details:
Languages:  eng     Pagination:  222-9     Citation Subset:  IM    
Childbearing and Health (ReaCH) Group, Lancashire, United Kingdom.
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MeSH Terms
Birthing Centers*
Delivery, Obstetric / methods
Episiotomy / utilization
Germany / epidemiology
Great Britain / epidemiology
Infant Mortality
Infant, Newborn
Patient Transfer / statistics & numerical data
United States / epidemiology

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