Tracy, S. K., Sullivan, E., Dahlen, H., Balck D., Wang, Y. A., & Tracy, M. B. (2006). BJOG An International Journal of Obstetrics and Gynaecology, 113, 86-96.

The aim of this huge study was to determine if women who deliver in low-volume maternity hospitals were at a disadvantage. For some time, in countries with high medical standards we have observed an increased medical focus on maternity care. Although well intentioned, the results have been rising rates of medical intervention, particularly for low-risk women, and increased costs of healthcare. The trend has been to close down smaller maternity hospitals and encourage all women to deliver in hospitals with larger capacities. These changes are supported by the belief that large-volume hospitals have high quality care. In this study in Australia, where maternity care has features of both the British and the U.S. systems (everyone is covered by a national healthcare system for prenatal care but 30% of women also have private coverage), data were gathered from 331,147 Australian women who were medically "low risk." Information was collected for demographic factors, pregnancy and labor characteristics, and neonatal outcome. The hospitals were divided into five groups based on annual rates of delivery: (a) fewer than 100 deliveries, (b) 101 to 500 deliveries, (c) 501 to 1,000 deliveries, (d) 1,001 to 2,000 deliveries, and (e) more than 2,001 deliveries. All the hospitals were medically governed, and midwives employed by hospitals attended all births. The hospitals in Category e (more than 2,001 deliveries) were used as the reference point. The results of this study showed that fewer women in the Group a hospitals were induced or had instrumental birth or cesarean birth and fewer infants were admitted to the NICU. Intrathecal analgesia and neonatal death were less likely in Groups a through d. Cesarean birth (after labor) was less likely in Groups a, b, and d rather than Group e. The authors concluded that lower hospital volume is not associated with adverse outcome for low-risk women in Australia.

Sigridur Sia Jonsdottir