title: Is the operative delivery rate in low-risk women dependent on the level of birth care? A randomised controlled trial.
abstract: OBJECTIVE
  To investigate possible differences in operative delivery rate among low-risk women, randomised to an alongside midwifery-led unit or to standard obstetric units within the same hospital.
  
  
  METHODS
  Randomised controlled trial.
  
  
  METHODS
  Department of Obstetrics and Gynaecology, Østfold Hospital Trust, Tromsø, Norway.
  
  
  METHODS
  A total of 1111 women assessed to be at low risk at onset of spontaneous labour.
  
  
  METHODS
  Randomisation into one of three birth units: the special unit; the normal unit; or the midwife-led unit.
  
  
  METHODS
  Total operative delivery rate, augmentation, pain relief, postpartum haemorrhage, sphincter injuries and intrapartum transfer, Apgar score <7 at 5 minutes, metabolic acidosis and transfer to neonatal intensive care unit.
  
  
  RESULTS
  There were no significant differences in total operative deliveries between the three units: 16.3% in the midwife-led unit; 18.0% in the normal unit; and 18.8% in the special unit. There were no significant differences in postpartum haemorrhage, sphincter injuries or in neonatal outcomes. There were statistically significant differences in augmentation (midwife-led unit versus normal unit RR 0.73, 95% CI 0.59-0.89; midwife-led unit versus special unit RR 0.69, 95% CI 0.56-0.86), in epidural analgesia (midwife-led unit versus normal unit RR 0.68, 95% CI 0.52-0.90; midwife-led unit versus special unit RR 0.64, 95% CI 0.47-0.86) and in acupuncture (midwife-led unit versus normal unit RR 1.45, 95% CI 1.25-1.69; midwife-led unit versus special unit RR 1.45, 95% CI 1.22-1.73).
  
  
  CONCLUSIONS
  The level of birth care does not significantly affect the rate of operative deliveries in low-risk women without any expressed preference for level of birth care.
authors.affiliation: Department of Obstetrics and Gynaecology at Østfold Hospital Trust, Fredrikstad, Norway. stiber@so-hf.no
authors.forename: S
authors.initials: S
authors.lastname: Bernitz
authors.forename: R
authors.initials: R
authors.lastname: Rolland
authors.forename: E
authors.initials: E
authors.lastname: Blix
authors.forename: M
authors.initials: M
authors.lastname: Jacobsen
authors.forename: K
authors.initials: K
authors.lastname: Sjøborg
authors.forename: P
authors.initials: P
authors.lastname: Øian
mesh_terms: D015667:Acupuncture Analgesia / Q000706:statistics & numerical data; D000328:Adult; D001003:Anal Canal / Q000293:injuries; D015360:Analgesia, Epidural / Q000706:statistics & numerical data; D001034:Apgar Score; D002585:Cesarean Section / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008880:Midwifery / Q000706:statistics & numerical data*; D009664:Norway; D009775:Obstetrics and Gynecology Department, Hospital / Q000706:statistics & numerical data*; D010360:Patient Transfer / Q000706:statistics & numerical data; D006473:Postpartum Hemorrhage / Q000453:epidemiology; D011247:Pregnancy; D012307:Risk Factors; D014620:Vacuum Extraction, Obstetrical / Q000706:statistics & numerical data*; D055815:Young Adult