Hofmeyr George Justus, Mancotywa Thozeka, Silwana-Kwadjo Nomvula, Mgudlwa Batembu, Lawrie Theresa A, Gülmezoglu Ahmet Metin
Effective Care Research Unit, University of Fort Hare, Private Bag X9047, East London, South Africa.
Walter Sisulu University, Mthatha, Eastern Cape, South Africa.
BMC Pregnancy Childbirth. 2014 Dec 20;14:417. doi: 10.1186/s12884-014-0417-8.
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.
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.
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.
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.
南非的卫生系统基于初级保健模式，即社区卫生中心和诊所提供低风险孕产妇护理，二级/三级医院提供“高风险”护理。这种模式的缺点是，在原本低风险的妊娠中，意外分娩并发症的管理会出现延迟，因此，有必要重新评估南非的分娩护理模式。迄今为止，东开普省已设立了两个由初级保健现场助产士主导的分娩单元（OMBU）。OMBU类似于附属助产单元，但已根据南非卫生系统进行了调整，因为它们由初级保健服务机构配备人员、管理和提供资金。它们允许被认为“低风险”的女性在社区卫生中心分娩和在OMBU分娩之间进行选择。
本次审计的目的是评估在南非东伦敦的弗雷尔妇产医院设立一个OMBU对孕产妇服务的影响。我们对OMBU开放前后两个12个月期间从弗雷尔妇产医院常规收集的数据进行了审计。回顾性检索的数据包括出生人数、孕产妇和围产期死亡人数以及分娩方式。
弗雷尔妇产医院的OMBU开放后，医院内的出生总数增加了16%。医院产科单元（OU）的出生总数下降了9.3%，7375例中有1611例（22%）在新的OMBU出生。与OMBU开放前相比，OMBU开放后的孕产妇和围产期死亡人数有所下降。由于观察性研究容易产生偏差，因此不能将这些改善视为干预的结果。
死亡率数据的解释应谨慎，因为风险状况的变化等其他因素可能导致了死亡人数的减少。这种模式对女性、医院工作人员和初级保健工作人员还有许多其他好处，而且可能比标准（独立）初级保健模式更具成本效益。
