Child births in a modified midwife managed unit: Selection and transfer according to intended place of delivery

Background. As small obstetrical departments may not be able to give second -level perinatal care, the delivery unit at Lofoten hospital was for the ye ars 1997-98 reorganized to a modified midwife managed unit. Women at low ob stetrical risk were delivered at this unit and women at high risk were refe rred to the central hospital. We assessed the effectiveness of the risk sel ection. Material and methods. The study was a prospective, pragmatic, population-ba sed trial. Desired outcome was defined as a non-operative delivery at 35-42 weeks gestational age giving an infant not needing resuscitation. Intermed iate outcomes: Operative deliveries, infants transferred to neonatal intens ive care unit and infants diverging from normal. The intended place of deli very was ultimately decided at admittance to the midwife managed unit. Results. Of the 628 women in study 435 (69.3%) gave birth at the midwife ma naged unit, 152 (24.2%) were selected to be delivered at the central hospit al and 41 (6.5%) were transferred to the central hospital after admittance to the midwife managed unit. Desired outcome was recorded in 94% of the del iveries at the midwife managed unit as compared to 50.3% at the central hos pital. Women who intended to be delivered at the midwife managed unit, need ed fewer operative deliveries and relatively few infants were transferred t o the neonatal intensive care unit or diverged from normal. Conclusions. As nearly 70% of the births occurred at the midwife managed un it and 94% of these deliveries had a desired outcome, this indicates an eff ective selection process. This model might be an alternative to centralizat ion of births in sparsely population areas.