title: Freestanding midwifery units: Maternal and neonatal outcomes following transfer.
abstract: BACKGROUND
  the viability of freestanding midwifery units in Australia is restricted, due to concerns over their safety, particularly for women and babies who, require transfer.
  
  
  OBJECTIVE
  to compare the maternal and neonatal birth outcomes of women who planned, to give birth at freestanding midwifery units and subsequently, transferred to a tertiary maternity unit to the maternal and neonatal, outcomes of a low-risk cohort of women who planned to give birth in, tertiary maternity unit.
  
  
  METHODS
  a descriptive study compared two groups of women with low-risk singleton, pregnancies who were less than 28 weeks pregnant at booking: women who, planned to give birth at a freestanding midwifery unit (n=494) who, transferred to a tertiary maternity unit during the antenatal, intrapartum or postnatal periods (n=260) and women who planned to give, birth at a tertiary maternity unit (n=3157). Primary outcomes were mode, of birth, Apgar score of less than 7 at 5minutes and admission to, special care nursery or neonatal intensive care.
  
  
  RESULTS
  the proportion of women who experienced a caesarean section was lower, among the freestanding midwifery unit women who transferred during the, intrapartum/postnatal period compared to women in the tertiary maternity, unit group (16.1% versus 24.8% respectively). Other outcomes were, comparable between the cohorts. Rates of primary outcomes in relation to, stage of transfer varied when stratified by parity.
  
  
  CONCLUSIONS
  these descriptive results support the provision of care in freestanding, midwifery units as an alternative to tertiary maternity units for women, with low risk pregnancies at the time of booking. A larger study, powered, to determine statistical significance of any differences in outcomes, is, required.
authors.affiliation: F,aculty of Health, the University of Technology Sydney, PO Box 222, Ultimo, 2007 NSW, Australia. Electronic address: amy.monk@uts.edu.au.
authors.forename: Amy R
authors.initials: AR
authors.lastname: Monk
authors.affiliation: School of Health Sciences, Division of Midwifery, Floor 12, Tower Block, Park Campus, University of Nottingham, Nottingham NG7 2RD, England, UK.
authors.forename: Celia P
authors.initials: CP
authors.lastname: Grigg
authors.affiliation: F,aculty of Health, the University of Technology Sydney, PO Box 222, Ultimo, 2007 NSW, Australia.
authors.forename: Maralyn
authors.initials: M
authors.lastname: Foureur
authors.affiliation: Department of Paediatrics and Child Health, The University of Sydney, Sydney, 2050 NSW, Australia.
authors.forename: Mark
authors.initials: M
authors.lastname: Tracy
authors.affiliation: Midwifery and Women's Health Research Unit, The Royal Hospital for Women, Level 1, Barker Street, Randwick, 2031 NSW Australia.
authors.forename: Sally K
authors.initials: SK
authors.lastname: Tracy
mesh_terms: D000328:Adult; D001034:Apgar Score; D001315:Australia; D016550:Birthing Centers / Q000592:standards* / Q000706:statistics & numerical data; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D008880:Midwifery / Q000379:methods / Q000592:standards* / Q000706:statistics & numerical data; D062209:Patient Handoff / Q000592:standards* / Q000706:statistics & numerical data; D063868:Patient Outcome Assessment; D011247:Pregnancy; D014163:Transfer, Psychology
keywords: Childbirth; Freestanding midwifery unit; Midwifery; Place of birth; Tertiary Hospital; Transfer