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Babies born before arrival to hospital and maternity unit closures in Queensland and Australia

  • Sue Kildea
    Correspondence
    Corresponding author at: Mater Health Services, Level 1, Aubigny Place, Raymond Terrace, South Brisbane, Qld 4101, Australia. Tel.: +61 073163 6388.
    Affiliations
    Midwifery Research Unit, Mater Research Institute, The University of Queensland, Mater Health Services, Level 1, Aubigny Place, Raymond Terrace, South Brisbane, Qld 4101, Australia

    School of Nursing and Midwifery, The University of Queensland, Qld 4101, Australia
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  • Alexandra C. McGhie
    Affiliations
    Midwifery Research Unit, Mater Research Institute, Australian Catholic University, 1100 Nudgee Road, Banyo, Qld 4014, Australia
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  • Yu Gao
    Affiliations
    Midwifery Research Unit, Mater Research Institute, The University of Queensland, Mater Health Services, Level 1, Aubigny Place, Raymond Terrace, South Brisbane, Qld 4101, Australia

    School of Nursing and Midwifery, The University of Queensland, Qld 4101, Australia
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  • Alice Rumbold
    Affiliations
    Robinson Institute, The University of Adelaide, Australia
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  • Margaret Rolfe
    Affiliations
    University Centre for Rural Health, The University of Sydney, Australia
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      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

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      References

        • Department of Health and Aging
        Improving maternity services in Australia: the report of the Maternity Services Review.
        2009 (Canberra, ACT)
        • Hoang H.
        • Le Q.
        • Kilpatrick S.
        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
        • Rural Doctors Association of Australia
        Maternity services for rural Australia.
        2006 (Canberra, ACT)
        • Brown M.
        • Deitsch E.
        The feasibility of caseload midwifery in rural Australia: a literature review.
        Women Birth. 2013; 26: e1-e4
        • Ravelli A.
        • Jager K.
        • De Groot M.
        • Erwich J.
        • Rijninks-van Driel G.
        • Tromp M.
        • et al.
        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
        • Grzybowski S.
        • Stoll K.
        • Kornelsen J.
        Distance matters: a population based study examining access to maternity services for rural women.
        BMC Health Serv Res. 2011; 11: 147
        • Viisainen K.
        • Gissler M.
        • Hartikainen A.
        • Hemminki E.
        Accidental out-of-hospital births in Finland: incidence and geographical distribution 1963–1995.
        Acta Obstet Gynecol Scand. 1999; 78: 372-378
        • Tracy S.
        • Sullivan E.
        • Dahlen H.
        • Black D.
        • Wang Y.
        • Tracy M.
        Does size matter? A population-based study of birth in lower volume maternity hospitals for low risk women.
        Gen Obstet. 2006; 113: 86-96
        • Hoang H.
        • Le Q.
        • Terry D.
        Women's access needs in maternity care in rural Tasmania, Australia: a mixed methods study.
        Women Birth. 2014; 27: 9-14
        • Moster D.
        • Lie R.
        • Markestad T.
        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
        • Moster D.
        • Lie R.
        • Markestad T.
        Neonatal mortality rates in communities with small maternity units compared with those having larger maternity units.
        Br J Obstet Gynaecol. 2001; 108: 904-909
        • Klein M.
        • Christilaw J.
        • Johnston S.
        Loss of maternity care: the cascade of unforeseen dangers.
        Can J Rural Med. 2002; 7: 120-121
        • National Association of Specialist Obstetricians and Gynaecologists
        Submission to Maternity Services Review.
        2008 (Sydney, NSW)
        • Cameron B.
        • Cameron S.
        Outcomes in rural obstetrics, Atherton Hospital 1991–2000.
        Aust J Rural Health. 2001; 9: 39-42
        • Van Wagner V.
        • Epoo B.
        • Nastapoka J.
        • Harney E.
        Reclaiming birth, health, and community: midwifery in the Inuit villages of Nunavik, Canada.
        J Midwifery Women's Health. 2007; 52: 384-391
        • Van Wagner V.
        • Osepchook C.
        • Harney E.
        • Crosbie C.
        • Tulugak M.
        Remote midwifery in Nunavik, Quebec, Canada: outcomes of perinatal care for the Inuulitsivik Health Centre, 2000–2007.
        Birth. 2012; 39
        • Tracy S.K.
        • Dahlen H.
        • Caplice S.
        • Laws P.
        • Wang Y.A.
        • Tracy M.B.
        • et al.
        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
        • Lumley J.
        The safety of small maternity hospitals in Victoria 1982–84.
        Community Health Stud. 1988; 12: 386-393
        • Kildea S.
        • Kruske S.
        • Barclay L.
        • Tracy S.
        ‘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
        • Kornelsen J.
        • Grzybowski S.
        Safety and community: the maternity care needs of rural parturient women.
        J Obstet Gynaecol Can. 2005; 27: 554-561
        • Nesbitt T.
        • Larson E.
        • Rosenblatt R.
        • Hart L.
        Access to maternity care in rural Washington: its effect on neonatal outcomes and resource use.
        Am J Public Health. 1997; 87: 85-90
        • Roach S.
        • Downes S.
        Caring for Australia's most remote communities obstetric services in the Indian Ocean Territories.
        Rural Remote Health. 2007; 7: 699
        • Kornelsen J.
        • Stoll K.
        • Grzybowski S.
        Stress and anxiety associated with lack of access to maternity services for rural parturient women.
        Aust J Rural Health. 2011; 19: 9-14
        • Deitsch E.
        • Shackleton P.
        • Davies C.
        • Alston M.
        • McLeod M.
        ‘Mind you, there's no anaesthetist on the road’: women's experiences of labouring en route.
        Rural Remote Health. 2010; 10: 1371
        • Department of Health and Aging
        Improving Maternity Services in Australia: a discussion paper from the Australian Government.
        2008 (Canberra)
        • Australian Government
        National maternity services plan.
        Australian Health Ministers Advisory Council, Commonwealth of Australia, Canberra2011
        • Holmes J.
        • Charles-Edwards E.
        • Bell M.
        Population dynamics in rural and remote Queensland.
        Queensland Centre for Population Research, School of Geography, Planning and Architecture, University of Queensland, Brisbane2005
        • Australian Institute of Health and Welfare
        Australia's health 2008.
        2008 (Canberra)
        • Hirst C.
        Re-birthing. Report of the review of maternity services in Queensland.
        2005
        • Queensland Centre for Mothers & Babies
        Rural birth summits.
        2013 (Available from: http://www.qcmb.org.au/ruralbirth [cited 2013])
        • McLelland G.
        • McKenna L.
        • Archer F.
        No fixed place of birth: unplanned BBAs in Victoria, Australia.
        Midwifery. 2013; 29: 19-25
        • Blondel B.
        • Drewniak N.
        • Pilkington H.
        • Zeitlin J.
        Out-of-hospital births and the supply of maternity units in France.
        Health Place. 2011; 17: 1170-1173
        • Ford J.
        • Pett G.
        ‘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
        • Beeram M.
        • Solarin K.
        • Young M.
        • Abedin M.
        Morbidity and mortality of infants born before arrival at the hospital.
        Clin Pediatr (Phila). 1995; 34: 313-316
        • Bhoopalam P.
        • Watkinson M.
        Babies born before arrival at hospital.
        Br J Obstet Gynaecol. 1991; 98: 57-64
        • Jones P.
        • Alberti C.
        • Jule L.
        • Chabernaud J.
        • Node N.
        • Sieurin A.
        • et al.
        Mortality in out-of-hospital premature births.
        Acta Paediatr. 2011; 100: 181-187
        • Rodie V.
        • Thomson A.
        • Norman J.
        Accidental out-of-hospital deliveries: an obstetric and neonatal case control study.
        Acta Obstet Gynecol Scand. 2002; 81: 50-54
        • Lazić Z.
        • Takač I.
        Outcomes and risk factors for unplanned delivery at home and before arrival to the hospital.
        Wien Klin Wochenschr. 2011; 123: 11-14
        • Ireland S.
        • Wullili Narjic C.
        • Belton S.
        • Kildea S.
        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
        • Jackson M.
        • Dahlen H.
        • Schmied V.
        Birthing outside the system: perceptions of risk amongst Australian women who have freebirths and high risk homebirths.
        Midwifery. 2012; 28: 561-567
        • McLelland G.
        • Morgans A.
        • McKenna L.
        Involvement of emergency medical services at unplanned births before arrival to hospital: a structured review.
        Emerg Med J. 2013; ([E-pub ahead print])
        • AIHW
        Perinatal national minimum data set: national health data dictionary, version 12.
        National Health Data Dictionary. Cat. no. HWI 59, Canberra2003
        • Gosden A.
        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
        • Tracy S.
        It's happening – midwifery led maternity services at last!.
        2005
        • Heller G.
        • Richardson D.
        • Schnell R.
        • Misselwitz B.
        • Künzel W.
        • Schmidt S.
        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
        • AHMAC
        Primary maternity services in Australia: a framework for implementation.
        Australian Health Ministers Advisory Council, 2008
        • Birthplace in England Collaborative Group
        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
        • Overgaard C.
        • Møller A.M.
        • Fenger-Grøn M.
        • Knudsen L.B.
        • Sandall J.
        Freestanding midwifery unit versus obstetric unit: a matched cohort study of outcomes in low-risk women.
        BMJ Open. 2011; 1
        • Rogers C.
        • Pickersgill J.
        • Palmer J.
        • Broadbent M.
        Informing choices: outcomes for women at a stand-alone birth centre.
        Br J Midwifery. 2010; 18: 8-15
        • David M.
        • Pachaly J.
        • Vetter K.
        • Kentenich H.
        Birthplace free-standing birth centre – perinatal data in comparison with clinic deliveries in Bavaria and Berlin.
        Z Geburtshilfe Neonatol. 2004; 2008: 110-117
        • Tucker J.
        • McVicar A.
        • Pitchforth E.
        • Farmer J.
        • Bryers H.
        Maternity care models in a remote and rural network: assessing clinical appropriateness and outcome indicators.
        Qual Safe Health Care. 2013; 2010: 83-89
        • Davis D.
        • Baddock S.
        • Pairman S.
        • Hunter M.
        • Benn C.
        • Wilson D.
        • et al.
        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
        • Leeman L.
        • Leeman R.
        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
        • Barlow K.
        • Hunter M.
        • Conroy C.
        • Lennan M.
        An evaluation of the midwifery services at a NZ community maternity unit (birth centre).
        NZCOM J. 2004; 31: 7-12
        • Hunter M.
        • Pairman S.
        • Benn C.
        • Baddock S.
        • Davis D.
        • Herbison P.
        • et al.
        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
        • Scherman S.
        • Smith J.
        • Davidson M.
        The first year of a midwifery-led model of care in Far North Queensland.
        Med J Aust. 2008; 188: 85-88
        • Kruske S.
        • Schultz T.
        • Eales S.
        • Kildea S.
        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])
        • Monk A.
        • Tracy M.
        • Foureur M.
        • Grigg C.
        • Tracy S.
        Evaluating Midwifery Units (EMU): a prospective cohort study of freestanding midwifery units in New South Wales, Australia.
        BMJ Open. 2014; 4