Highlights: First 100 Babies Report

The Ryde Group Midwifery Practice

Ryde Midwifery Group Practice was launched on 15th March 2004. A six months transition period followed. This is a report card of the first 100 intended bookings at Ryde. The Ryde Midwifery Group Practice offers the benefits of continuity of midwifery care to low-risk non-insured women who book with a named midwife at their local hospital.

Midwives and women are guided by the National Midwifery Guidelines for Consultation and Referral to decide where to book – Royal North Shore Hospital, or Ryde. Primary-level maternity and newborn care is offered at Royal North Shore and Ryde Hospitals for families from a culturally and linguistically diverse (CALD) population. In this first evaluation of the new service there were no maternal or neonatal adverse outcomes.

All babies were born in good health and were discharged home with their mothers after birth. Ryde Midwifery Group Practice was Highly Commended in the NSW State Treasury Managed Funds Risk Management Awards.

Citation

“In recognition of the development and implementation of an innovative midwifery led model of maternity care for Ryde hospital”. (TMF 2004) Cultural diversity of Ryde familiesMothers

• From September 1st, 2004 until January 31st 2005 there were 103 women who intended to book at Ryde. Of these, 50 (48.5%) were primiparous and 53 (51.5%) were multiparous.
• Average age was 29.4 years ranging from 16 to 40 years (SD 5 .4)

All the women who gave birth at Ryde had a spontaneous onset of labour and spontaneous vaginal birth.

• At Ryde the average time for 1st stage of labour was 5 hours (median of 4 hours); average length of 2nd stage of labour was 56 mins (median 33mins).
• The average blood loss was 213 ml (min 100 – max 600.)
• Of the 56 women who gave birth at Ryde most women did not require additional pain relief other than position changes and
  • nitrous oxide (14)
  • water (4)
  • opioids (1)

Of the women who gave birth at Ryde, 76% had intact perineum (43/56 women).

No episiotomies were performed at Ryde. There were no 3rd-degree tears at Ryde, and 13/56 women required sutures following birth. For pain relief in labour: Rate of antepartum transfer 29% Rate of intrapartum transfer 10% Postpartum transfer – 1 babyFor comparable Australian data see:

Byrne et al (2000): Peripartum transfer rate: 64%

Homer at al (2000): Intrapartum transfer rate 30% A free standing birth centre is an institution that offers care to women with a straightforward pregnancy and where midwives take primary professional responsibility for care. During labour and birth medical services, including obstetric, neonatal and anaesthetic care are available should they be needed, but they may be on a separate site which may involve transfer by car or ambulance.

Compared with Australian national data (2002), the RMGP shows a significantly higher rate of spontaneous vaginal birth, lower Caesarean section and lower instrumental birth rate. This may be associated with the lack of induction and the lack of epidurals at Ryde. During the antenatal period, the midwives referred 30 women to RNS hospitals (29%). Of these women 13 were booked into RNS without any consultation at Ryde; others were transferred when antenatal factors developed.

The RMGP midwives continued to provide labour and birth care for 8 women who transferred to RNS to give birth. The transfer rate shows a conservative index of referral and consultation with obstetric care at RNS consistent with expectations of the new midwifery-led model, and compares favourably with other published rates (see refs). Six families left the district after booking with the RMGP.

Reasons for antenatal transfer included:

• Induction of labour (11)
  • post dates pregnancy (8) referred at 41 completed weeks
  • Hypertension (3)
• PROM (2)
• Hypertension in pregnancy (3)
• Gestational diabetes (2)
• Pre-term (2)
• Antepartum bleeding (1)
• Previous PPH (1)
• Congenital anomaly (2)
• Ryde hosp. closed (1)
• serious medical conditions apparent at booking in (5)

During labour 11 women who began labour at Ryde were transferred to give birth at RNS. Of these women; 7 were transferred by ambulance; and the others travelled in their own car. Average time between calling the ambulance and arrival was 13 minutes (range 0-30 mins). Average transfer time by ambulance 21 minutes (10 -30 mins). The average time from arrival until consultation at RNS was 13 mins (5-25 mins).

Reasons for intrapartum transfer included:

Prolonged 2nd stage (5) resulting in:

• C Sections (2)
• Forceps delivery (3)
• C Section (3)

Prolonged 1st stage (3) resulting in: Requested epidural (2) resulting in:

• C Section (1)
• SVB (1)

Intrapartum Haemorrhage (1) 750ml Following birth 1 women was transferred to RNS hospital for care of her baby.

Babies

Babies born at Ryde: had Apgars of 9 & 9; did not require resuscitation, admission to the neonatal unit or re-admission to hospital following discharge. All babies were breastfed at birth and 2 babies were not breastfeeding on discharge from postnatal visiting. Following intrapartum transfer to RNS hospital for 11 women who had a vaginal birth or Caesarean section, 10 babies had a 5 min Apgar of 9; 1 baby had 5 min Apgar 7.

References:

1. Byrne JP, Crowther CA, Moss JR (2000) A randomised controlled trial comparing birth centre care with delivery suite care in Adelaide, Australia Australian and New Zealand Journal of Obstetrics and Gynaecology 40 (3) 268-274
2. Homer C, Davis G, Petocz P, Barclay L, Matha D, Chapman M (2000) Birth centre or labour ward? A comparison of the clinical outcomes of low risk women in a NSW hospital Australian Journal of Advanced Nursing 18 (1) 8-12
3. Waldenström U and Lawson J (1998) Birth centre practices in Australia Australian and New Zealand Journal of Obstetrics and Gynaecology 34 (1) 31-34