title: Trend analysis of primary midwife-led delivery care at a Japanese perinatal center.
abstract: OBJECTIVE
  To perform trend analysis of primary midwife-led delivery care for 'low risk' pregnant women at our hospital.
  
  
  METHODS
  A retrospective cohort study was performed to examine trends and outcomes of labor under primary midwife-led delivery care at the Japanese Red Cross Katsushika Maternity Hospital between 2008 and 2012.
  
  
  RESULTS
  During the study period, the rate of deliveries initially considered 'low risk' decreased from 25 to 22% (p < 0.01). This change was associated with increased cases of previous Cesarean deliveries and preterm delivery. There were no significant changes in the neonatal outcomes; however, the rate of Cesarean delivery and incidence of severe perineal laceration in primary midwife-led delivery care were decreased from 2.1 and 3.3% to 0.3 (p = 0.02) and 1.1% (p = 0.04), respectively due to the close cooperation between midwives and obstetricians.
  
  
  CONCLUSIONS
  The rate of deliveries initially considered 'low risk' decreased over the last 5-year period. Closer cooperation between midwives and obstetricians is important in primary midwife-led delivery care.
authors.affiliation: Department of Obstetrics and Gynecology, Japanese Red Cross Katsushika Maternity Hospital, Tokyo, Japan.
authors.forename: Shunji
authors.initials: S
authors.lastname: Suzuki
mesh_terms: D000328:Adult; D002585:Cesarean Section; D036861:Delivery, Obstetric; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007564:Japan; D008880:Midwifery; D018743:Perinatal Care; D011247:Pregnancy
keywords: Japan.; Midwife-led care; obstetric shared care; referral