title: Different settings of place of midwife-led birth: evaluation of a midwife-led birth centre.
abstract: OBJECTIVE
  The claimed advantages of home deliveries, including fewer medical interventions, are potentially counter balanced by the small additional risk on perinatal adverse outcome compared to hospital deliveries in low risk women. Homelike birth centres have been proposed a new setting for low risk women combining the advantages of home and hospital, resulting in lower intervention rates with equal safety. This paper addresses whether the introduction of a midwife-led birth centre adjacent to the hospital combines the advantages of home and hospital deliveries. Additionally, we investigate whether the introduction of a midwife-led birth centre leads to a different risk selection of women planning their delivery either at home, at the hospital or at the birth centre.
  
  
  METHODS
  Anonymized data, between January 2007 and June 2012, was collected from the four participating midwife practices. Women (n = 5558) were categorized according to intended place of birth. Women's characteristics and pregnancy outcomes were compared between the period before and after its introduction using Chi square and Fisher's Exact tests. Direct and indirect standardized rates were calculated for different outcomes [(1) intrapartum and neonatal mortality (<24 h), (2) composite outcome of neonatal morbidities, (3) composite outcome of maternal morbidities, and (4) medical intervention], taking the period before introduction as reference.
  
  
  RESULTS
  After the introduction of the birth centre a different risk selection was observed. Women's characteristics were most unfavourable for intended birth centre births. Additionally, an higher neonatal risk load was seen within these women. After its introduction neonatal morbidities decreased (5.0 vs. 3.8 %) and maternal morbidities decreased (8.3 vs. 7.3 %). Interventions were about equal. Direct and indirect standardization provided similar results.
  
  
  CONCLUSIONS
  Neonatal morbidity and maternal morbidity tended to decrease, while overall intervention rates were unaffected. The introduction of the midwife-led birth centre seems to benefit the outcome of midwife-led deliveries. We interpret this change by the redistribution of the higher risk women among the low risk population intending birth at the birth centre instead of home.
authors.affiliation: Division of Obstetrics and Prenatal Medicine, Room Hs-408, Department of Obstetrics and Gynaecology, Erasmus MC, PO Box 2040, 3000 CA Rotterdam, The Netherlands.
authors.forename: Jacoba
authors.initials: J
authors.lastname: van der Kooy
authors.affiliation: Division of Obstetrics and Prenatal Medicine, Room Hs-408, Department of Obstetrics and Gynaecology, Erasmus MC, PO Box 2040, 3000 CA Rotterdam, The Netherlands.
authors.forename: Johanna P
authors.initials: JP
authors.lastname: de Graaf
authors.affiliation: Division of Obstetrics and Prenatal Medicine, Room Hs-408, Department of Obstetrics and Gynaecology, Erasmus MC, PO Box 2040, 3000 CA Rotterdam, The Netherlands ; Institute of Health Policy and Management, Erasmus University Rotterdam, PO Box 1738, 3000 DR Rotterdam, The Netherlands.
authors.forename: Doctor Erwin
authors.initials: DE
authors.lastname: Birnie
authors.affiliation: Division of Obstetrics and Prenatal Medicine, Room Hs-408, Department of Obstetrics and Gynaecology, Erasmus MC, PO Box 2040, 3000 CA Rotterdam, The Netherlands.
authors.forename: Semiha
authors.initials: S
authors.lastname: Denktas
authors.affiliation: Division of Obstetrics and Prenatal Medicine, Room Hs-408, Department of Obstetrics and Gynaecology, Erasmus MC, PO Box 2040, 3000 CA Rotterdam, The Netherlands.
authors.forename: Eric A P
authors.initials: EA
authors.lastname: Steegers
authors.affiliation: Division of Obstetrics and Prenatal Medicine, Room Hs-408, Department of Obstetrics and Gynaecology, Erasmus MC, PO Box 2040, 3000 CA Rotterdam, The Netherlands ; Rotterdam Midwifery Academic (Verloskunde Academie Rotterdam), Dr. Molewaterplein 40, 3015 GD Rotterdam, The Netherlands ; Department of Public Health, Erasmus MC, PO Box 2040, 3000 CA Rotterdam, The Netherlands.
authors.forename: Gouke J
authors.initials: GJ
authors.lastname: Bonsel
keywords: Birth centre; Maternal outcome; Midwife-led care; Perinatal outcome