Department of Health Science and Technology, Aalborg University, 9220Aalborg, Denmark.
BMC Public Health. 2012 Jun 22;12:478. doi: 10.1186/1471-2458-12-478.
Social inequity in perinatal and maternal health is a well-documented health problem even in countries with a high level of social equality. We aimed to study whether the effect of birthplace on perinatal and maternal morbidity, birth interventions and use of pain relief among low risk women intending to give birth in two freestanding midwifery units (FMU) versus two obstetric units in Denmark differed by level of social disadvantage.
The study was designed as a cohort study with a matched control group. It included 839 low-risk women intending to give birth in an FMU, who were prospectively and individually matched on nine selected obstetric/socio-economic factors to 839 low-risk women intending OU birth. Educational level was chosen as a proxy for social position. Analysis was by intention-to-treat.
Women intending to give birth in an FMU had a significantly higher likelihood of uncomplicated, spontaneous birth with good outcomes for mother and infant compared to women intending to give birth in an OU. The likelihood of intact perineum, use of upright position for birth and water birth was also higher. No difference was found in perinatal morbidity or third/fourth degree tears, while birth interventions including caesarean section and epidural analgesia were significantly less frequent among women intending to give birth in an FMU. In our sample of healthy low-risk women with spontaneous onset of labour at term after an uncomplicated pregnancy, the positive results of intending to give birth in an FMU as compared to an OU were found to hold for both women with post-secondary education and the potentially vulnerable group of FMU women without post-secondary education. In all cases, women without post-secondary education intending to give birth in an FMU had comparable and, in some respects, more favourable outcomes when compared to women with the same level of education intending to give birth in an OU. In this sample of low-risk women, we found that the effect of intended place on birth outcomes did not differ with women's level of education.
FMU care appears to offer important benefits for birthing women with no additional risk to the infant. Both for women with and without post-secondary education, intending to give birth in an FMU significantly increased the likelihood of a spontaneous, uncomplicated birth with good outcomes for mother and infant compared to women intending to give birth in an OU. All women should be provided with adequate information about different care models and supported in making an informed decision about the place of birth.
即使在社会平等程度较高的国家，围产期和产妇健康方面的社会不平等也是一个有据可查的健康问题。我们旨在研究在丹麦的两个独立助产士单位（FMU）与两个产科单位中，出生地点对低危产妇围产期和产妇发病率、分娩干预和使用止痛药物的影响是否因社会劣势程度而不同。
该研究设计为队列研究，设有匹配对照组。它纳入了 839 名有低危妊娠打算在 FMU 分娩的妇女，这些妇女前瞻性地根据 9 项选定的产科/社会经济因素，与 839 名有低危妊娠打算在 OU 分娩的妇女逐一进行匹配。教育水平被选为社会地位的替代指标。分析按意向治疗进行。
与有低危妊娠打算在 OU 分娩的妇女相比，有低危妊娠打算在 FMU 分娩的妇女顺产且母婴结局良好的可能性显著更高。会阴完整、采用直立分娩姿势和水中分娩的可能性也更高。围产期发病率或第三/四级撕裂无差异，而在 FMU 分娩的妇女中，剖宫产和硬膜外镇痛等分娩干预明显较少。在我们的样本中，健康的低危产妇在足月时自然临产，妊娠过程顺利，与有低危妊娠打算在 OU 分娩的妇女相比，打算在 FMU 分娩的妇女的积极结果适用于接受过中学后教育的妇女和 FMU 中没有接受过中学后教育的潜在脆弱群体。在所有情况下，没有接受过中学后教育但有低危妊娠打算在 FMU 分娩的妇女，与具有相同教育水平但有低危妊娠打算在 OU 分娩的妇女相比，具有可比性，在某些方面具有更有利的结局。在这个低危产妇样本中，我们发现，意图分娩地点对分娩结果的影响不因妇女的教育程度而不同。
FMU 护理似乎为分娩妇女带来了重要的益处，对婴儿没有额外的风险。对于接受过中学后教育和没有接受过中学后教育的妇女，与有低危妊娠打算在 OU 分娩的妇女相比，有低危妊娠打算在 FMU 分娩显著增加了自然分娩、无并发症且母婴结局良好的可能性。所有妇女都应获得有关不同护理模式的充分信息，并支持她们就分娩地点做出知情决策。
