Births in two different delivery units in the same clinic – A prospective study of healthy primiparous women

Eligible participants were low-risk primiparas who met the criteria for delivery in the midwife-led ward regardless of which cohort they were allocated to. The two wards are localised at the same floor. Women in both cohorts received the same standardized public antenatal care by general medical practitioners and midwifes who were not involved in the delivery. After admission of a woman to the midwife-led ward, the next woman who met the inclusion criteria, but preferred delivery at the conventional delivery ward, was allocated to the conventional delivery ward cohort. Among the 252 women in the midwife-led ward cohort, 74 (29%) women were transferred to the conventional delivery ward during labour.Emergency caesarean and instrumental delivery rates in women who were admitted to the midwife-led and conventional birth wards were statistically non-different, but more women admitted to the conventional birth ward had episiotomy. More women in the conventional delivery ward received epidural analgesia, pudental nerve block and nitrous oxide, while more women in the midwife-led ward received opiates and non-pharmacological pain relief.We did not find evidence that starting delivery in the midwife-led setting offers the advantage of lower operative delivery rates. However, epidural analgesia, pudental nerve block and episiotomies were less often while non-pharmacological pain relief was often used in the midwife-led ward.In many places world-wide all births are concentrated to larger maternity clinics, regardless of whether the woman is seen as a healthy, low-risk woman, or whether there are underlying illness or other risk factors existent. During recent decades, particularly in parts of the world with thriving private practice, obstetricians have increasingly taken over responsibility for normal birth [1,2]. Concomitantly, routine use of intervention such as episiotomy, electronic foetal monitoring and pain control by systemic agents, that are not evidence based [3] and