Safety and outcomes of mothers and children.

Midwives must preserve and protect the physiological process of childbirth while ensuring the safety of mother and child. The sociological and midwifery approach towards health assumes that safety is not only defined by physical factors but also takes into account the mental, emotional, spiritual and social needs of women. Safe outcomes of childbirth therefore include the physical health of the mother and child as well as the content and satisfaction with the experience and services.

The Directorate of Health publishes guidelines on the choice of place of birth, and these guidelines are followed in all respects when women are advised on whether the Reykjavík Birth Center is a suitable place to give birth. In the birth itself, there are always two midwives who have the role of assessing the progress of labor, ensuring that it continues to proceed normally. The midwives support the parents during labor and birth, making sure that the mother and child feel well and assess the need for transfer to a higher level of medical care if circumstances require.

During the first few hours after giving birth, the midwives continue to care for the family to ensure that everyone is doing well in addition to providing assistance with breastfeeding. If the woman gives birth at the birth center, the family will be able to go home after a short postpartum stay. For the first home care visitation, the midwives will visit the family at their home within 6 to 8 hours after giving birth. Home care services will be provided once to twice a day from 7 up to 10 days depending on the needs of the family. With this model, we can ensure continuity of care since the midwives care for the family during pregnancy, in labor and childbirth and in the postpartum period as well.

Continuity of care guarantees the safety of women and their babies because trust has developed between the expectant parents and the midwives. The midwives have had an opportunity to listen to the wishes of the expectant parents and to get to know their story. Therefore, they are able to respond to any situations that may arise in collaboration with the parents. Many studies show that this increases safety in care.

In certain situations, there may be a need to change plans. This may involve consulting a doctor or another midwife during pregnancy or even transferring to another place of birth during labor. This is always done in close collaboration with healthcare professionals at Health Centers in the Capital Area and Landspítali Hospital.

Research has shown better outcomes for healthy women in normal pregnancies who intend to give birth in midwifery-led units compared to those who intend to give birth in high-tech hospitals. These women are less likely to require contraction stimulating medication, instrumental birth, cesarean section, epidural analgesia or episiotomy. Serious perineal tears and postpartum hemorrhage are also less likely to occur among these women. Studies have also shown equally good results for children of healthy women who have had normal pregnancies who are born in midwifery-led units and those who give birth in high-tech hospitals. This information is based on international research which shows that continuous midwifery-led services in maternity care result in better outcomes for both mother and child and is the basis for the guidelines on the choice of place of birth published by the Directorate of Health which we adhere to in Iceland.