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BJOG. 2012 Aug;119(9):1081-90. doi: 10.1111/j.1471-0528.2012.03414.x. Epub 2012 Jun 18.

Transfers of women planning birth in midwifery units: data from the birthplace prospective cohort study.

Author information

1
National Perinatal Epidemiology Unit, University of Oxford, Oxford, UK. rachel.rowe@npeu.ox.ac.uk

Erratum in

  • BJOG. 2013 May;120(6):790.

Abstract

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.

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