THE STOCKHOLM BIRTH CENTER TRIAL - MATERNAL AND INFANT OUTCOME

Objective To compare an in-hospital birth centre with standard materni ty care regarding medical interventions and maternal and infant outcom e. Background The birth centre care was characterised by comprehensive antenatal, intrapartum and postpartum care with the same team of midw ives, restricted use of medical technology. and discharge within 24 h after birth. Methods Of 1860 women meeting low risk medical criteria i n early pregnancy and interested in birth centre care, 925 were random ly allotted birth centre care and 932 standard maternity care. Data we re collected mainly from hospital records, and analysis was by intenti on-to-treat. Results Of the women in the birth centre group, 13% were transferred antenatally and 19% intrapartum. No statistical difference s were observed in maternal morbidity or in perinatal mortality neonat al morbidity, Apgar score or infant admissions to neonatal care. Perin atal mortality, defined as intrauterine death after 22 weeks of gestat ion and infant death within seven days of birth, occurred in eight cas es (0.9%) in the birth centre group and in two cases (0.2%) in the sta ndard care group (OR 4.04, 95% CI 0.80 to 39 17; P = 0.11). Subgroup a nalysis showed that a larger proportion of first-born babies in the bi rth centre group (15.6%) were admitted for neonatal care than in the s tandard care group (9.5%) (P = 0.003), whereas; the converse was the c ase for the newborns of multiparous women: 4.7% and 8.4%, respectively (P = 0.04). The overall rates of operative delivery (e.g. caesarean s ection, vacuum extraction and forceps), 11.1% in the birth centre grou p and 13.4% in the standard care group, did not differ statistically ( P = 0.12), but obstetric analgesia, induction, augmentation of labour and electronic fetal monitoring were less frequently used in the birth centre group. Labour was 1 h longer in the birth centre group. Conclu sion Birth centre care was associated with less medical interventions than standard care without any statistically significant differences i n health outcomes, However, the excess of perinatal deaths and of morb idity in primigravidas' infants in the birth centre group gives cause for concern and necessitates further studies.