title: Audit of a new model of birth care for women with low risk pregnancies in South Africa: the primary care onsite midwife-led birth unit (OMBU).
abstract: BACKGROUND
  South Africa's health system is based on the primary care model in which low-risk maternity care is provided at community health centres and clinics, and 'high-risk' care is provided at secondary/tertiary hospitals. This model has the disadvantage of delays in the management of unexpected intrapartum complications in otherwise low-risk pregnancies, therefore, there is a need to re-evaluate the models of birth care in South Africa. To date, two primary care onsite midwife-led birth units (OMBUs) have been established in the Eastern Cape. OMBUs are similar to alongside midwifery units but have been adapted to the South African health system in that they are staffed, administered and funded by the primary care service. They allow women considered to be at 'low risk' to choose between birth in a community health centre and birth in the OMBU.
  
  
  METHODS
  The purpose of this audit was to evaluate the impact of establishing an OMBU at Frere Maternity Hospital in East London, South Africa, on maternity services. We conducted an audit of routinely collected data from Frere Maternity Hospital over two 12 month periods, before and after the OMBU opened. Retrospectively retrieved data included the number of births, maternal and perinatal deaths, and mode of delivery.
  
  
  RESULTS
  After the OMBU opened at Frere Maternity Hospital, the total number of births on the hospital premises increased by 16%. The total number of births in the hospital obstetric unit (OU) dropped by 9.3%, with 1611 births out of 7375 (22%) occurring in the new OMBU. The number of maternal and perinatal deaths was lower in the post-OMBU period compared with the pre-OMBU period. These improvements cannot be assumed to be the result of the intervention as observational studies are prone to bias.
  
  
  CONCLUSIONS
  The mortality data should be interpreted with caution as other factors such as change in risk profile may have contributed to the death reductions. There are many additional advantages for women, hospital staff and primary care staff with this model, which may also be more cost-effective than the standard (freestanding) primary care model.
authors.affiliation: Effective Care Research Unit, University of Fort Hare, Private Bag X9047, East London, South Africa. justhof@gmail.com.|Walter Sisulu University, Mthatha, Eastern Cape, South Africa. justhof@gmail.com.|Eastern Cape Department of Health, Frere Maternity Hospital, Private Bag X9047, East London, 5201, South Africa. justhof@gmail.com.
authors.forename: George Justus
authors.initials: GJ
authors.lastname: Hofmeyr
authors.affiliation: Eastern Cape Department of Health, Frere Maternity Hospital, Private Bag X9047, East London, 5201, South Africa. thozie2m@yahoo.com.
authors.forename: Thozeka
authors.initials: T
authors.lastname: Mancotywa
authors.affiliation: Eastern Cape Department of Health, Frere Maternity Hospital, Private Bag X9047, East London, 5201, South Africa. nomvula.kwadjo@impilo.ecprov.gov.za.
authors.forename: Nomvula
authors.initials: N
authors.lastname: Silwana-Kwadjo
authors.affiliation: Walter Sisulu University, Mthatha, Eastern Cape, South Africa. bara@mailbox.co.za.|Eastern Cape Department of Health, Frere Maternity Hospital, Private Bag X9047, East London, 5201, South Africa. bara@mailbox.co.za.
authors.forename: Batembu
authors.initials: B
authors.lastname: Mgudlwa
authors.affiliation: UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Reproductive Health and Research, World Health Organization, Avenue Appia 20, 1201, Geneva, Switzerland. tess@lawrie.com.
authors.forename: Theresa A
authors.initials: TA
authors.lastname: Lawrie
authors.affiliation: UNDP/UNFPA/UNICEF/WHO/World Bank Special Programme of Research, Development and Research Training in Human Reproduction (HRP), Department of Reproductive Health and Research, World Health Organization, Avenue Appia 20, 1201, Geneva, Switzerland. gulmezoglum@who.int.
authors.forename: Ahmet Metin
authors.initials: AM
authors.lastname: Gülmezoglu
mesh_terms: D003696:Delivery Rooms / Q000458:organization & administration / Q000706:statistics & numerical data*; D005260:Female; D006771:Hospitals, Maternity / Q000458:organization & administration / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008428:Maternal Mortality; D008485:Medical Audit; D008880:Midwifery; D009775:Obstetrics and Gynecology Department, Hospital / Q000706:statistics & numerical data; D018743:Perinatal Care; D054238:Perinatal Mortality; D011247:Pregnancy; D011295:Prenatal Care; D011320:Primary Health Care / Q000379:methods*; D012189:Retrospective Studies; D013019:South Africa