Transfers of care between healthcare professionals in obstetric units of different sizes: the MidconBirth study

Abstract Background: In Europe, the majority of healthy women give birth at conventional obstetric units with the assistance of registered midwives. Childbirth assistance offered in highly technological settings and the variability found in the intrapartum interventions performed are causes for concern. This study examines the relationships between the intrapartum transfer of care from midwife to obstetrician-led maternity care, obstetric unit size (OUS) with different degrees of midwifery autonomy, intrapartum interventions and birth outcomes. Methods: A prospective, multicenter, cross-sectional study promoted by the COST Action IS1405 was carried out at eight public hospitals in Europe. Data were collected through an online platform in 2016-2019. The primary outcome was transfer of care (TOC). The secondary outcomes included type of onset of labor, oxytocin stimulation, epidural analgesia, type of birth, episiotomy/perineal injury, postpartum hemorrhage, early initiation of breastfeeding and early skin-to-skin contact. Descriptive statistics were used to summarize the women’s characteristics. The Chi-square test was used to analyze the statistical significance of the differences in the percentages of hospital groups between the variable categories; an odds ratio (OR) with a 95% CI, was calculated. A logistic regression was performed to ascertain the effects of studied co-variables on the likelihood that participants had a transfer of care. The significance level was set at p <0.05. Results: Out of a total of 2,126 low-risk women, those whose intrapartum care was initiated by a midwife (1,772) were selected. There were statistically significant differences between transfer of care and OUS (S1=29.0%, S2=44.0%, S3=52.9%, S4=30.2%, p<0.001). Statistically significant differences between OUS and onset of labor, oxytocin stimulation, type of birth and episiotomy or perineal injury were observed (p=0.009, p<0.001, p<0.001, p<0.001 respectively). Conclusion: Findings suggest that the model of care and OUS have a significant effect on the prevalence of intrapartum transfer of care and the birth outcomes. Future research should examine how models of care differ as a function of the OUS in a hospital, as well as the cost-effectiveness for the health care system. Keywords: Midwife-led care; obstetrician-led care; continuity of care; transfer of care, maternal outcomes, neonatal outcomes