Elsevier

The Lancet

Volume 326, Issue 8452, 24 August 1985, Pages 429-432
The Lancet

Hospital Practice
IS OBSTETRICS SAFE IN SMALL HOSPITALS?: Evidence from New Zealand's Regionalised Perinatal System

https://doi.org/10.1016/S0140-6736(85)92747-3Get rights and content

Abstract

Perinatal mortality rates were determined for all public maternity hospitals in New Zealand for the years 1978-1981. Level 1 maternity hospitals—mostly small rural units staffed by general practitioners and midwives—had lower birth-weight-specific perinatal mortality rates in all but the lowest birth-weight categories than the better equipped hospitals to which they refer. This probably reflects the cautious antenatal practices of general practitioners, and the effective regionalisation of perinatal services in New Zealand. It is also possible that there is an advantage, particularly for normal birth-weight children, in being born in smaller obstetric units. There is no evidence that a satisfactory outcome depends on a minimum number of deliveries.

References (25)

  • WA. Bowes

    A review of perinatal mortality in Colorado, 1971 to 1978, and its relationship to the regionalization of perinatal services

    Am J Obstet Gynecol

    (1981)
  • Nk Roberts et al.

    The numbers game, or is small beautiful?

    N Engl J Med

    (1981)
  • Wp Longmire et al.

    Regionalization of operations

    N Engl J Med

    (1979)
  • Ha Hem

    Evaluation of a rural perinatal care system

    Pediatrics

    (1980)
  • MC. McCormick

    The regionalization of perinatal care

    Am J Public Health

    (1981)
  • Jf Vogt et al.

    Impact of a regional infant dispatch center on neonatal mortality

    Am J Public Health

    (1981)
  • D. Gillings et al.

    Analysis of interrupted time series mortality trends: An example to evaluate regionalized perinatal care

    Am J Public Health

    (1981)
  • A. Donabedian

    Volume, quality, and the regionalization of health care services

    Med Care

    (1984)
  • Ml Chiswick

    Perinatal referral: A time for decisions

    Br Med J

    (1982)
  • DB. Bonham

    Regional variations in perinatal mortality in New Zealand and their significance

    Aust NZ J Obstet Gynaecol

    (1969)
  • Maternity Services in New Zealand, Maternity Services Committee

    (1976)
  • Special Care Services for the Newborn in New Zealand

    (1982)
  • Cited by (82)

    • Confidence: Fundamental to midwives providing labour care in freestanding midwifery-led units

      2018, Midwifery
      Citation Excerpt :

      Small maternity units have existed since the early 1900s in New Zealand, featuring in both urban and rural localities. While regionalisation of maternity services resulted in a decline in births in these units from 28% in 1982 to 10% in 2015 (Ministry of Health, 2017; Rosenblatt et al., 1985), the remaining freestanding midwifery-led units provide a unique space for the process of normal labour and birth to unfold (Smythe et al., 2016). Epidural analgesia assisted birth and caesarean operations are not available in these units.

    • A retrospective, descriptive study of maternal and neonatal transfers, and clinical outcomes of a Primary Maternity Unit in rural Queensland, 2009-2011

      2015, Women and Birth
      Citation Excerpt :

      Current evidence demonstrates PMUs provide safe care for women classified as low-risk8,35–41 when compared to standard maternity care with no differences in perinatal mortality35,42; no difference or improved outcomes for perinatal morbidity35,36,42; improved outcomes for maternal morbidity36; less birth interventions including caesarean section8,35,36,40,42 and improved neonatal outcomes.40,41 While PMUs are uncommon in rural and remote Australia,2 in countries with comparable health systems (New Zealand, Canada) PMUs offer equitable and safe maternity care to rural women.43–45 New Zealand supports 58 primary units with 51 located in rural or remote settings, and 31 over an hour from tertiary services.46

    • Effect of patient risk on the volume-outcome relationship in obstetric delivery services

      2014, Health Policy
      Citation Excerpt :

      Some studies have found that hospitals with more deliveries had higher levels of perinatal care [12], lower maternal complication rates [13], and less mortality and morbidity compared with lower-volume hospitals [5]. However, a larger number of studies have found no such volume–outcome relationship in hospitals [14–20]. Volume–outcome theory implies that the volume of hospital deliveries is positively associated patient outcomes.

    • Perinatal health inequalities and accessibility of maternity services in a rural French region: Closing maternity units in Burgundy

      2013, Health and Place
      Citation Excerpt :

      However, data from the literature about the relation between volume and results in obstetrics are far from concordant. Research in numerous countries including Finland (Hemminki et al., 2011), Australia (Tracy et al., 2006), and New Zealand (Rosenblatt et al., 1985), has concluded that risk does not rise in small maternity units. In Germany, an increase in the risk of per-partum and neonatal mortality was observed in maternity units with fewer than 500 deliveries (Heller et al., 2002).

    • The association between hospital obstetrical volume and maternal postpartum complications

      2012, American Journal of Obstetrics and Gynecology
      Citation Excerpt :

      Previous studies that evaluated the volume-outcome relationship in obstetrics have been limited to studies from single state populations, to data that are now >1 decade old, and to conflicting results about the volume-outcome relationship.15-19 In addition, many previous obstetrics volume-outcome studies focused exclusively on neonatal outcomes without investigating maternal complications.27-33 Our study provides important new evidence of higher maternal complication rates at very low-volume hospitals.

    View all citing articles on Scopus
    View full text