OBJECTIVE: To examine the percentage of women transferred, reasons for transfer and factors associated with the transfer of women planning birth in midwifery units (MUs). DESIGN: Prospective cohort study. SETTING: All freestanding midwifery units (FMUs) and alongside midwifery units (AMUs) in England. PARTICIPANTS: Twenty-nine thousand, two hundred and forty-eight eligible women with a singleton, term and 'booked' pregnancy, planning birth in an MU between April 2008 and April 2010. METHODS: Multivariable logistic regression was used to explore the sociodemographic and clinical characteristics associated with transfer. MAIN OUTCOME MEASURES: Transfer during labour or within 24 hours of birth. RESULTS: Over one in four women were transferred from AMUs and over one in five from FMUs. In both types of MU, compared with multiparous women aged 25-29 years, nulliparous women aged <20 years had higher odds of transfer (FMU-adjusted odds ratio [OR], 4.5; 95% confidence interval [CI], 3.10-6.57; AMU-adjusted OR, 2.6; 95% CI, 2.18-2.06), and the odds of transfer increased with increasing age. Nulliparous women aged ≥ 35 years in FMUs had 7.4 times the odds of transfer (95% CI, 5.43-10.10) and, in AMUs, 6.0 times the odds of transfer (95% CI, 4.81-7.41). Starting labour care after 40 weeks of gestation and the presence of complicating conditions at the start of labour care were also independently associated with a higher risk of transfer. CONCLUSIONS: Transfer from MUs is common, especially for first-time mothers. This study provides evidence on the maternal characteristics associated with an increased risk of transfer, which can be used to inform women's choices about place of birth.
OBJECTIVE: To examine the percentage of women transferred, reasons for transfer and factors associated with the transfer of women planning birth in midwifery units (MUs). DESIGN: Prospective cohort study. SETTING: All freestanding midwifery units (FMUs) and alongside midwifery units (AMUs) in England. PARTICIPANTS: Twenty-nine thousand, two hundred and forty-eight eligible women with a singleton, term and 'booked' pregnancy, planning birth in an MU between April 2008 and April 2010. METHODS: Multivariable logistic regression was used to explore the sociodemographic and clinical characteristics associated with transfer. MAIN OUTCOME MEASURES: Transfer during labour or within 24 hours of birth. RESULTS: Over one in four women were transferred from AMUs and over one in five from FMUs. In both types of MU, compared with multiparous women aged 25-29 years, nulliparous women aged <20 years had higher odds of transfer (FMU-adjusted odds ratio [OR], 4.5; 95% confidence interval [CI], 3.10-6.57; AMU-adjusted OR, 2.6; 95% CI, 2.18-2.06), and the odds of transfer increased with increasing age. Nulliparous women aged ≥ 35 years in FMUs had 7.4 times the odds of transfer (95% CI, 5.43-10.10) and, in AMUs, 6.0 times the odds of transfer (95% CI, 4.81-7.41). Starting labour care after 40 weeks of gestation and the presence of complicating conditions at the start of labour care were also independently associated with a higher risk of transfer. CONCLUSIONS: Transfer from MUs is common, especially for first-time mothers. This study provides evidence on the maternal characteristics associated with an increased risk of transfer, which can be used to inform women's choices about place of birth.
Authors: Margaret H O'Hara; Linda M Frazier; Travis W Stembridge; Robert S McKay; Sandra N Mohr; Stuart L Shalat Journal: Birth Date: 2013-09 Impact factor: 3.689
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Authors: Yangmei Li; John Townend; Rachel Rowe; Marian Knight; Peter Brocklehurst; Jennifer Hollowell Journal: BMJ Open Date: 2014-01-17 Impact factor: 2.692
Authors: Asha Elizabeth Mathew; Anne George Cherian; Tobey Ann Marcus; Sam Marconi; Venkata Raghava Mohan; Jasmine Helan Prasad Journal: J Family Med Prim Care Date: 2021-07-02