Abstract
Background
Evidence suggests the closure of maternity units is associated with an increase in
babies born before arrival (BBA).
Aim
To explore the association between the number of maternity units in Australia and
Queensland by birthing numbers, BBA rate and geographic remoteness of the health district
where the mother lives.
Methods
A retrospective study utilised routinely collected perinatal data (1992–2011). Pearson
correlation tested the relationship between BBA rate and number of maternity units.
Linear regression examined this association over time.
Findings
During 1992–2011, the absolute numbers (N = 22,814) of women having a BBA each year in Australia increased by 47% (N = 836–1233); and 206% (n = 140–429) in Queensland. This coincided with a 41% reduction in maternity units in
Australia (N = 623–368 = 18 per year) and a 28% reduction in Queensland (n = 129–93). BBA rates increased significantly across Australia, r = 0.837, n = 20 years, p < 0.001 and Queensland, r = 0.917, n = 20 years, p < 0.001 and this was negatively correlated with the number of maternity units in Australia,
r = −0.804, n = 19 years, p < 0.001 and Queensland, r = −0.906, n = 19 years, p < 0.001.
Conclusions
The closure of maternity units over a 20-year period across Australia and Queensland
is significantly associated with increased BBA rates. The distribution is not limited
to rural and remote areas. Given the high risk of adverse maternal and neonatal outcomes
associated with BBA, it is time to revisit the closure of units.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Women and BirthAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Improving maternity services in Australia: the report of the Maternity Services Review.2009 (Canberra, ACT)
- Small rural maternity units without caesarean delivery capabilities: is it safe and sustainable in the eyes of health professionals in Tasmania?.Rural Remote Health. 2012; 12: 1941
- Maternity services for rural Australia.2006 (Canberra, ACT)
- The feasibility of caseload midwifery in rural Australia: a literature review.Women Birth. 2013; 26: e1-e4
- Travel time from home to hospital and adverse perinatal outcomes in women at term in the Netherlands.BJOG: Int J Obstet Gynaecol. 2011; 118: 457-465
- Distance matters: a population based study examining access to maternity services for rural women.BMC Health Serv Res. 2011; 11: 147
- Accidental out-of-hospital births in Finland: incidence and geographical distribution 1963–1995.Acta Obstet Gynecol Scand. 1999; 78: 372-378
- Does size matter? A population-based study of birth in lower volume maternity hospitals for low risk women.Gen Obstet. 2006; 113: 86-96
- Women's access needs in maternity care in rural Tasmania, Australia: a mixed methods study.Women Birth. 2014; 27: 9-14
- Relation between size of delivery unit and neonatal death in low risk deliveries: population based study.Arch Dis Child Fetal Neonatal Ed. 1999; 80: f221-f225
- Neonatal mortality rates in communities with small maternity units compared with those having larger maternity units.Br J Obstet Gynaecol. 2001; 108: 904-909
- Loss of maternity care: the cascade of unforeseen dangers.Can J Rural Med. 2002; 7: 120-121
- Submission to Maternity Services Review.2008 (Sydney, NSW)
- Outcomes in rural obstetrics, Atherton Hospital 1991–2000.Aust J Rural Health. 2001; 9: 39-42
- Reclaiming birth, health, and community: midwifery in the Inuit villages of Nunavik, Canada.J Midwifery Women's Health. 2007; 52: 384-391
- Remote midwifery in Nunavik, Quebec, Canada: outcomes of perinatal care for the Inuulitsivik Health Centre, 2000–2007.Birth. 2012; 39
- Birth centers in Australia: a national population-based study of perinatal mortality associated with giving birth in a birth center.Birth: Issues Perinatal Care. 2007; 34: 194-201
- The safety of small maternity hospitals in Victoria 1982–84.Community Health Stud. 1988; 12: 386-393
- ‘Closing the Gap’: how maternity services can contribute to reducing poor maternal infant health outcomes for Aboriginal and Torres Strait Islander women.Rural Remote Health. 2010; 10
- Safety and community: the maternity care needs of rural parturient women.J Obstet Gynaecol Can. 2005; 27: 554-561
- Access to maternity care in rural Washington: its effect on neonatal outcomes and resource use.Am J Public Health. 1997; 87: 85-90
- Caring for Australia's most remote communities obstetric services in the Indian Ocean Territories.Rural Remote Health. 2007; 7: 699
- Stress and anxiety associated with lack of access to maternity services for rural parturient women.Aust J Rural Health. 2011; 19: 9-14
- ‘Mind you, there's no anaesthetist on the road’: women's experiences of labouring en route.Rural Remote Health. 2010; 10: 1371
- Improving Maternity Services in Australia: a discussion paper from the Australian Government.2008 (Canberra)
- National maternity services plan.Australian Health Ministers Advisory Council, Commonwealth of Australia, Canberra2011
- Population dynamics in rural and remote Queensland.Queensland Centre for Population Research, School of Geography, Planning and Architecture, University of Queensland, Brisbane2005
- Australia's health 2008.2008 (Canberra)
- Re-birthing. Report of the review of maternity services in Queensland.2005
- Rural birth summits.2013 (Available from: http://www.qcmb.org.au/ruralbirth [cited 2013])
- No fixed place of birth: unplanned BBAs in Victoria, Australia.Midwifery. 2013; 29: 19-25
- Out-of-hospital births and the supply of maternity units in France.Health Place. 2011; 17: 1170-1173
- ‘BBA’ birth. Analysis of one year's ‘born before arrival’ births (n = 29) and trends in BBA birth 2000–07 in a large English maternity unit.MIDIRS Midwifery Digest. 2008; 18: 217-223
- Morbidity and mortality of infants born before arrival at the hospital.Clin Pediatr (Phila). 1995; 34: 313-316
- Babies born before arrival at hospital.Br J Obstet Gynaecol. 1991; 98: 57-64
- Mortality in out-of-hospital premature births.Acta Paediatr. 2011; 100: 181-187
- Accidental out-of-hospital deliveries: an obstetric and neonatal case control study.Acta Obstet Gynecol Scand. 2002; 81: 50-54
- Outcomes and risk factors for unplanned delivery at home and before arrival to the hospital.Wien Klin Wochenschr. 2011; 123: 11-14
- Niyith Niyith Watmum the quiet story: exploring the experiences of Aboriginal women who give birth in their remote community.Midwifery. 2010; https://doi.org/10.1016/j.midw.2010.05.009
- Birthing outside the system: perceptions of risk amongst Australian women who have freebirths and high risk homebirths.Midwifery. 2012; 28: 561-567
- Involvement of emergency medical services at unplanned births before arrival to hospital: a structured review.Emerg Med J. 2013; ([E-pub ahead print])
- Perinatal national minimum data set: national health data dictionary, version 12.National Health Data Dictionary. Cat. no. HWI 59, Canberra2003
- A report on the development of a midwifery model of care for the Joyce Palmer Health Service (Palm Island).Townsville Health Service District, Queensland Health, Townsville2008
- It's happening – midwifery led maternity services at last!.2005
- Are we regionalized enough? Early-neonatal deaths in low-risk births by the size of delivery units in Hesse, Germany 1990–1999.Int J Epidemiol. 2002; 31: 1061-1068
- Primary maternity services in Australia: a framework for implementation.Australian Health Ministers Advisory Council, 2008
- Perinatal and maternal outcomes by planned place of birth for healthy women with low risk pregnancies: the Birthplace in England national prospective cohort study.BMJ. 2011; 343
- Freestanding midwifery unit versus obstetric unit: a matched cohort study of outcomes in low-risk women.BMJ Open. 2011; 1
- Informing choices: outcomes for women at a stand-alone birth centre.Br J Midwifery. 2010; 18: 8-15
- Birthplace free-standing birth centre – perinatal data in comparison with clinic deliveries in Bavaria and Berlin.Z Geburtshilfe Neonatol. 2004; 2008: 110-117
- Maternity care models in a remote and rural network: assessing clinical appropriateness and outcome indicators.Qual Safe Health Care. 2013; 2010: 83-89
- Planned place of birth in New Zealand: does it affect mode of birth and intervention rates among low-risk women?.Birth: Issues Perinatal Care. 2011; 38: 111-119
- Do all hospitals need cesarean delivery capability? An outcomes study of maternity care in a rural hospital without on-site cesarean capability.J Fam Pract. 2002; 51: 129-134
- An evaluation of the midwifery services at a NZ community maternity unit (birth centre).NZCOM J. 2004; 31: 7-12
- Do low risk women actually birth in their planned place of birth and does ethnicity influence women's choices of birthplace?.NZCOM J. 2011; 44: 5-11
- The first year of a midwifery-led model of care in Far North Queensland.Med J Aust. 2008; 188: 85-88
- A retrospective, descriptive study of maternal and neonatal transfers, and clinical outcomes of a Primary Maternity Unit in rural Queensland, 2009–2011.Women Birth. 2014; ([E-pub ahead print])
- Evaluating Midwifery Units (EMU): a prospective cohort study of freestanding midwifery units in New South Wales, Australia.BMJ Open. 2014; 4
Article info
Publication history
Published online: April 03, 2015
Accepted:
March 14,
2015
Received in revised form:
March 12,
2015
Received:
December 24,
2014
Identification
Copyright
© 2015 Australian College of Midwives. Published by Elsevier Inc. All rights reserved.
