Changes to booking, transfer criteria and procedures in birth centres in Australia from 1997-2007 : a national survey

Background. Approximately 2% of women who give birth in Australia each year do so in a birth centre. A national study on birth centre procedures was conducted in 1997. There have been changes in the management of women in birth centres during the past 10years and this may be due in part to changes in booking and transfer criteria. Aims. This study aimed to describe booking and transfer criteria and procedures available in birth centres in Australia in 2007 and to compare results with those of a previous national birth centre study undertaken in 1997. Design. Survey. Methods. Questionnaires were sent to 23 birth centres. Questions included: types of procedures, equipment and pain relief available and exclusion criteria for booking and transfer. Of the birth centres, 19 satisfied the inclusion criteria and 16 completed surveys. Results. Changes were noted in booking and transfer criteria and procedures for birth centres between 1997-2007. These included a decline in birth centres accepting postterm pregnancies, vaginal births after caesarean section and women who are obese. There were also reductions in the use of artificial rupture of membranes for augmentation of labour, forceps and opioids. Use of natural therapies was widespread in 2007. Increases in birth centres managing induction of labour and electronic fetal monitoring were also noted. Conclusions. The changes observed in birth centre practice reflect overall changes in maternity care in Australia from 1997-2007. Relevance to clinical practice. Findings of the study suggest that factors such as increasing obesity and limited admission for vaginal births after caesarean section may lead to proportionately more women being unable to access birth centres as their preferred place of birth.