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What is Primary Birthing?

Primary Birthing at The Birthing Centre NZWhat is Primary Birthing in New Zealand?

Primary Birthing is when a woman with a low risk pregnancy chooses to have a natural birth without intervention and with a midwife.

The woman and the midwife work together using alternative birthing practices such as water, heat or massage to manage the labour and the birth.

The best place for this to happen is in a primary birthing setting where midwives work together to achieve the birth the woman has planned during her pregnancy.

It is acknowledged that not all women are able to have their babies in a primary birthing unit and to ensure that they achieve the best outcome for themselves and their babies they need to birth in a maternity facility whereby they can receive the Obstetric care they need.

But for women with a healthy low risk pregnancy the best choice for them is in  a primary birthing setting. Birthing Centre can offer women a supportive home environment away from home.

Why a primary birthing unit?

A recent New Zealand study published in the British Medical Journal by Grigg et al, (2017) looked at the outcomes for well women choosing to birth in a midwife-led primary maternity unit in New Zealand concluded that, for well women that planned to birth in these units they had better outcomes.

This study showed:

  • significantly higher likelihood that the women will have a spontaneous vaginal birth
  • significantly less likely to have an instrumental assisted vaginal birth   
  • there were no significant differences in the Apgar scores at 5 minutes
  • there were no significant differences in the rates of babies being admitted to the Neonatal Units

Another New Zealand study Birth outcomes for women using freestanding birth centres in South Auckland. (D. Bailey,2017) found:

  • significantly lower rates of instrumental and caesarean section
  • Lower rates of blood transfusion
  • Lower rates of admissions to neonatal units for babies birthed by first time Mothers

New Zealand study by D. Davis et al (2011) also showed:

  • Lower risk of caesarean section, assisted modes of birth (instrumental) and less interventions in labour.
  • Fewer babies were admitted to neonatal units.

The evidence is there to support women choosing to birth in a primary birthing centre and this is using New Zealand research which does mirror overseas results as well.  Birthing in a Primary Birthing Centre is a safe option for healthy women and their babies.

The need to transfer

Should there be a need for the woman to transfer to a secondary/tertiary maternity facility, Birthing Centre has a process in place and the track record to date has demonstrated 100% success rate. A review of all BCL transfers has shown that the most common reason for transfer is in labour for “slow progress” and the women have been transferred to receive the appropriate support they have needed such as an epidural. Grigg et al 2015 found in their NZ study when looking at timing and reasons for transfer from a primary care centre that 12.6% of women transferred after admission in labour for “slow progress”. Slow progress in labour is not considered an obstetric emergency and is diagnosed by the midwife who has been monitoring the progress of the labour with the woman therefore the transfer to another maternity facility is done in a timely manner.

Place of birth: whose choice is it?

New Zealand is very fortunate in having primary birthing units, unfortunately these don’t exist in many other developed countries. (Alison Eddy, NZCOM, Dec 2017).

The New Zealand Model of Maternity Care which is the envy of women around the world, gives the women the opportunity to make choices about their pregnancy, and this includes their carer and their place of birth.

While the Ministry of Health (2016) has the national average for New Zealand women birthing in a primary setting as 10%. The figures for the  women in the Waikato region are above the national average at  28% of the women birthed in a primary care unit. There is also an expectation that there will be an increase in these numbers when the MOH release the updated figures.

It is the well women themselves that have the right to choose their place of birth, just as they have the right to choose the midwife that will be their Lead Maternity Carer throughout the pregnancy, labour and birth and then for the postnatal care.

Women need to be fully informed and given the opportunity to choose where they wish to birth. Planning the place of birth needs to be considered early in the pregnancy, so that there is time to consider all the options and visit the primary birthing centre before a decision is made. If the midwife they have chosen doesn’t support them with their choices they then need to consider whether the partnership is the right one for them.