Birth Centre

Birth Centres are small maternity units run by midwives, providing a more home-like setting for birth. They are managed by and are generally located within public maternity hospitals, but some centres are located separately from the hospital. Most Birth Centres have inclusion criteria which mean that the service can only be used by 'low risk' pregnant women. The most recent statistics for births in Victoria in 2007-2008, showed that 77% of women who planned to give birth in a Birth Centre had a normal vaginal birth.

Birth Centres are midwifery led units generally located within a public hospital, although there are a few free-standing public and private birth centres in Australia. They are run either as a Team Midwifery model of care, where a team of midwives provides complete care to the women during pregnancy, labour and birth, or as a Caseload Midwifery model, sometimes called Midwifery Group Practice, which allocates one midwife to work with one woman throughout her pregnancy, labour and the early weeks of parenting.

Birth centres have a midwifery philosophy which works on the basis that pregnancy and birth are healthy life events, and that for the vast majority of women, there is little need to intervene in the birth process. This is a 'low-risk' model of care, which means that women have to meet certain criteria in order to qualify for care under this model. Birth Centres are run by midwives. However, they generally operate under the wider hospital’s guidelines for care of pregnant women and babies, often being overseen by obstetric management.

Birth centres are designed to look and feel more like a home with soft furnishings and double beds, and medical equipment either hidden from view or kept outside the room. As they are part of the hospital, these facilities are relatively easy to access in an emergency.

Birth centres offer you and your partner the opportunity to stay together after the birth of your baby, for between 24 and 48 hours, depending upon how busy the centre is. Once you return home, a birth centre midwife may visit you once or twice to provide postnatal care.

The number of Midwifery Group Practices is increasing in Australia, although Birth Centres in some Australia states are in decline. Due to the limited number of places available in these programs, they book up quickly. If you think that you might be interested in Birth Centre or Caseload Midwifery Care, call your local maternity hospital to find out what is available in your area. The sooner you do it, the more likelihood you have of this being an option for you.

The most up-to-date research we have indicates that midwifery-led hospital birth centres are associated with lower rates of medical interventions during labour and birth and higher levels of satisfaction in women, without increasing the risk to mothers or babies (Hodnett et al. 2012).

Benefits of team midwifery care in a Birth Centre:

• The costs are covered by Medicare;
• You will have support to create an appropriate environment in which to labour including privacy, darkness, quiet, warmth and access to warm water;
• Women tend to feel more relaxed and able to respond spontaneously to their labour
• you may be able to stay in the bath or pool to give birth if facilities are available.

Women who were allocated to midwifery-led settings had an increased the likelihood of:

• a spontaneous vaginal birth;
• breastfeeding at six to eight weeks;
• and very positive views of care.

Women in these settings had a decreased likelihood of:

• requiring an epidural or any other drug for pain relief in labour;
• requiring an intravenous drip of artificial oxytocin to speed labour up;
• requiring vacuum or forceps assistance with the birth;
• receiving an episiotomy.

Disadvantages of team midwifery care in a Birth Centre:

• There may not be a birth centre near where you live or it may already be booked out;
• This is a low risk model of care, and there will be a list of inclusion criteria which you must meet to be eligible for Birth Centre care;
• You might not know the midwife who cares for you during labour;
• Each midwife will have a slightly different set of values and preferences for providing care during labour and birth;
• The midwife caring for you will leave when her shift ends and another midwife will take over your care;
• Staffing issues may result in the birth centre being unable to accommodate you and you will be requested to go to the Labour Ward to give birth;
• To access an epidural for pain relief you will need to transfer to the Labour Ward;
• Not all Birth Centres can provide you with access to a bath of warm water for pain relief, though most have a shower in each room;
• After you have had your baby, you will have to either go home or move to the maternity ward within 24-48 hours.

Caseload Midwifery Care

Caseload Midwifery Care or Midwifery Group Practice (MGP) models of care mean that you can be cared for by the same midwife throughout your pregnancy, birth and the first few weeks with your new baby. Your midwife (primary midwife) is supported by a small group of 2-3 midwives who might provide back-up care to you if your primary midwife is not available. Midwifery care focuses on your individual needs. There are a growing number of Midwifery Group Practices in Australia, many are located in Birth Centres but some are located within large hospital maternity services. It is worth asking about whether your hospital has a Midwifery Group Practice at your booking in appointment, or even earlier as these programs are very popular.

Benefits of caseload midwifery care in a Birth Centre:

• You will know and the midwife who will be caring for you, and she will know your birth preferences in detail;
• You will have support to control the environment in which you labour including privacy, darkness, noise, warmth and access to warm water;
• Women tend to feel more relaxed and able to respond spontaneously to their labour;
• You may be able to stay in the bath or pool to give birth if facilities are available;
• Your midwife visits you at home for up to 4 weeks after your baby’s birth.

Women who had midwife-led caseload models of care were less likely to experience:

• a preterm birth;
• their baby dying before 24 weeks’ gestation;
• the need to use drugs during labour, including an epidural;
• an episiotomy;
• a forceps or vacuum birth.

and were more likely to experience:

• a spontaneous vaginal birth;
• being cared for by a known midwife;
• a longer labour.

There were no difference between groups for:

• caesarean births;
• fetal loss / neonatal death of at least 24 weeks;
• overall fetal / neonatal death.

Disadvantages of caseload midwifery care in a Birth Centre:

• The birth centre will allocated a primary midwife to you rather than you being able to make an active choice;
• Your primary midwife may not be able to attend your birth;
• This is a low risk model of care and may not available for women who have had a previous caesarean, or those with a breech presentation or twins for example;
• There may be not be a caseload midwifery program near where you live or it may already be booked out;
• Staffing issues may result in the birth centre being unable to accommodate you and you will be requested to go with your midwife to the Labour Ward to give birth;
• To access an epidural for pain relief you will need to transfer to the Labour Ward;
• Not all birth centres can provide you with access to a bath of warm water for pain relief, though most have a shower in each room;
• You will have to either go home or move to the maternity ward 24-48 hours after having your baby.

References

• Hodnett ED, Downe S, Walsh D. (2012). Alternative versus conventional institutional settings for birth. Cochrane Database of Systematic Reviews 2012, Issue 8. Art. No.: CD000012. DOI: 10.1002/14651858.CD000012.pub4.
• Sandall, J., Soltani, H., Gates, S. et al (2013). Midwife-led continuity models versus other models of care for childbearing women. Cochrane Database of Systematic Reviews, Issue 8. Available online at http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD004667.pub3/abstract.