title: Evaluating Midwifery Units (EMU): a prospective cohort study of freestanding midwifery units in New South Wales, Australia.
abstract: OBJECTIVE
  To compare maternal and neonatal birth outcomes and morbidities associated with the intention to give birth in two freestanding midwifery units and two tertiary-level maternity units in New South Wales, Australia.
  
  
  METHODS
  Prospective cohort study.
  
  
  METHODS
  494 women who intended to give birth at freestanding midwifery units and 3157 women who intended to give birth at tertiary-level maternity units. Participants had low risk, singleton pregnancies and were at less than 28(+0) weeks gestation at the time of booking.
  
  
  METHODS
  Primary outcomes were mode of birth, Apgar score of less than 7 at 5 min and admission to the neonatal intensive care unit or special care nursery. Secondary outcomes were onset of labour, analgesia, blood loss, management of third stage of labour, perineal trauma, transfer, neonatal resuscitation, breastfeeding, gestational age at birth, birth weight, severe morbidity and mortality.
  
  
  RESULTS
  Women who planned to give birth at a freestanding midwifery unit were significantly more likely to have a spontaneous vaginal birth (AOR 1.57; 95% CI 1.20 to 2.06) and significantly less likely to have a caesarean section (AOR 0.65; 95% CI 0.48 to 0.88). There was no significant difference in the AOR of 5 min Apgar scores, however, babies from the freestanding midwifery unit group were significantly less likely to be admitted to neonatal intensive care or special care nursery (AOR 0.60; 95% CI 0.39 to 0.91). Analysis of secondary outcomes indicated that planning to give birth in a freestanding midwifery unit was associated with similar or reduced odds of intrapartum interventions and similar or improved odds of indicators of neonatal well-being.
  
  
  CONCLUSIONS
  The results of this study support the provision of care in freestanding midwifery units as an alternative to tertiary-level maternity units for women with low risk pregnancies at the time of booking.
authors.affiliation: Faculty of Nursing and Midwifery, The University of Sydney, Sydney, New South Wales, Australia.
authors.forename: Amy
authors.initials: A
authors.lastname: Monk
authors.affiliation: Centre for Newborn Care, Westmead Hospital and The University of Sydney, Sydney, New South Wales, Australia.
authors.forename: Mark
authors.initials: M
authors.lastname: Tracy
authors.affiliation: Centre for Midwifery, Child and Family Health, Faculty of Health, The University of Technology Sydney, Sydney, Australia.
authors.forename: Maralyn
authors.initials: M
authors.lastname: Foureur
authors.affiliation: Faculty of Nursing and Midwifery, The University of Sydney, Sydney, New South Wales, Australia.
authors.forename: Celia
authors.initials: C
authors.lastname: Grigg
authors.affiliation: Centre for Midwifery & Women's Health Nursing Research Unit, The Royal Hospital for Women and the University of Sydney, Sydney, Australia.
authors.forename: Sally
authors.initials: S
authors.lastname: Tracy
mesh_terms: D000328:Adult; D001034:Apgar Score; D016550:Birthing Centers; D002585:Cesarean Section / Q000706:statistics & numerical data; D015331:Cohort Studies; D003696:Delivery Rooms; D036861:Delivery, Obstetric / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007363:Intensive Care Units, Neonatal / Q000706:statistics & numerical data*; D007751:Labor, Induced / Q000706:statistics & numerical data; D008297:Male; D008880:Midwifery / Q000706:statistics & numerical data*; D009517:New South Wales; D017063:Outcome Assessment, Health Care; D010360:Patient Transfer / Q000706:statistics & numerical data; D011247:Pregnancy; D011446:Prospective Studies
keywords: Birthing centres, free-standing; Cohort studies; Delivery room; Midwifery; OBSTETRICS; Pregnancy