Birth outcomes in a tertiary teaching hospitals and local outposts: a novel approach to service delivery from Iran

• We examine 1 year clinical outcomes from two out-of-hospital birth centres in the suburbs.
• Out-of-hospital birth did not necessarily increase risk for mother or neonate.
• A well-organized referral system is necessary to respond to unpredictable complications.
• Use of outcome events rather than the endpoint outcomes helps to address any identified weakness or failures.
• Lack of procedures for integrating data across facilities was a big problem to improve the system.

ObjectiveThe aim of this study was to compare the outcomes of childbirth care in a tertiary teaching hospital and Safe Delivery Posts (SDPs) to determine the safety of out-of-hospital care by midwives in Zahedan, Iran.Study designA quasi-experimental design was applied in this study.MethodsIn this study, 2063 women who gave birth in SDPs, along with 983 women who underwent vaginal delivery in a tertiary teaching hospital, were evaluated in 2011–2012. Retrospective chart review was applied to collect data from the medical records of mothers and neonates. Only low-risk women with a singleton live birth, cephalic presentation, gestational age ≥37 weeks, spontaneous labour, and no prior history of uterine scar were recruited.ResultsBased on the findings, episiotomy, perineal tear, cervical laceration, postpartum haemorrhage and need for blood transfusion (or hysterectomy) were less commonly reported in the SDP group, compared to the hospital group. In the SDP group, 15 (0.73%) women were transferred to the hospital after delivery. Overall, one (0.10%) case from the hospital group and two (0.10%) cases from the SDP group were admitted to the intensive care unit. One-minute Apgar score lower than seven, resuscitation, NICU admission and neonatal death were more commonly reported in the hospital group, compared to the SDP group. Overall, hospital transfer was reported in 12 (0.58%) neonates born in SDPs.ConclusionIn the present study, women who gave birth in SDPs had more opportunities to experience natural birth with fewer adverse outcomes. However, considering the possibility of life-threatening complications for mothers and newborns, substantial evidence is required to improve the quality of care before implementing such novel strategies in different settings.