{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,13]],"date-time":"2026-01-13T21:32:33Z","timestamp":1768339953998,"version":"3.49.0"},"reference-count":35,"publisher":"Wiley","issue":"12","license":[{"start":{"date-parts":[[2024,9,15]],"date-time":"2024-09-15T00:00:00Z","timestamp":1726358400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100004690","name":"Minist\u00e8re de la Sant\u00e9","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100004690","id-type":"DOI","asserted-by":"publisher"}]},{"DOI":"10.13039\/501100004431","name":"Fondation de France","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100004431","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["obgyn.onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Acta Obstet Gynecol Scand"],"published-print":{"date-parts":[[2024,12]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Introduction<\/jats:title><jats:p>The establishment of midwife\u2010led birth centers (MLBCs) is still being debated. The study aimed to compare severe adverse outcomes and mode of birth in low\u2010risk women according to their birth planned in MLBCs or in obstetric\u2010led units (OUs) in France.<\/jats:p><\/jats:sec><jats:sec><jats:title>Material and Methods<\/jats:title><jats:p>We used nationwide databases to select low\u2010risk women at the start of care in labor in MLBCs (<jats:italic>n<\/jats:italic>\u2009=\u20091294) and in OUs (<jats:italic>n<\/jats:italic>\u2009=\u20095985). Using multilevel logistic regression, we compared severe adverse maternal and neonatal morbidity as a composite outcome and as individual outcomes. These include severe postpartum hemorrhage (\u22651000\u2009mL of blood loss), obstetrical anal sphincter injury, maternal admission to an intensive care unit, maternal death, a 5\u2010minute Apgar score\u2009&lt;7, neonatal resuscitation at birth, neonatal admission to an intensive care unit, and stillbirth or neonatal death. We also studied the mode of birth and the role of prophylactic administration of oxytocin at birth in the association between birth settings and severe postpartum hemorrhage.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>Severe adverse maternal and neonatal outcome indicated a slightly higher rate in women in MLBCs compared to OUs according to unadjusted analyses (4.6% in MLBCs vs. 3.4% in OUs; cOR 1.36; 95%CI [1.01\u20131.83]), but the difference was not significant between birth settings after adjustment (aOR 1.37 [0.92\u20132.05]). Severe neonatal morbidity alone was not different (1.7% vs. 1.6%; aOR 1.17 [0.55\u20132.47]). However, severe maternal morbidity was significantly higher in MLBCs than in OUs (3.0% vs. 1.9%; aOR 1.61 [1.09\u20132.39]), mainly explained by higher risks of severe postpartum hemorrhage (2.4 vs. 1.1%; aOR 2.37 [1.29\u20134.36]), with 2 out of 5 in MLBCs partly explained by the low use of prophylactic oxytocin. Cesarean and operative vaginal births were significantly decreased in women with a birth planned in MLBCs.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>In France, 3 to 4% of low\u2010risk women experienced a severe adverse maternal or neonatal outcome regardless of the planned birth setting. Results were favorable for MLBCs in terms of mode of birth but not for severe postpartum hemorrhage, which could be partly addressed by revising practices of prophylactic administration of oxytocin.<\/jats:p><\/jats:sec>","DOI":"10.1111\/aogs.14971","type":"journal-article","created":{"date-parts":[[2024,9,16]],"date-time":"2024-09-16T02:10:15Z","timestamp":1726452615000},"page":"2465-2474","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":3,"title":["Severe adverse maternal and neonatal outcomes according to the planned birth setting being midwife\u2010led birth centers or obstetric\u2010led units"],"prefix":"10.1111","volume":"103","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2637-4065","authenticated-orcid":false,"given":"Clara","family":"Rollet","sequence":"first","affiliation":[{"name":"Center of Research in Epidemiology and StatisticS (CRESS), Obstetrical Perinatal and Pediatric Epidemiology Research Team (EPOP\u00e9), INSERM, INRA Universit\u00e9 Paris Cit\u00e9  Paris France"},{"name":"Port Royal Maternity Unit, Cochin Hospital, Assistance Publique\u2010H\u00f4pitaux de Paris Universit\u00e9 Paris Cit\u00e9  Paris France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Camille","family":"Le Ray","sequence":"additional","affiliation":[{"name":"Center of Research in Epidemiology and StatisticS (CRESS), Obstetrical Perinatal and Pediatric Epidemiology Research Team (EPOP\u00e9), INSERM, INRA Universit\u00e9 Paris Cit\u00e9  Paris France"},{"name":"Port Royal Maternity Unit, Cochin Hospital, Assistance Publique\u2010H\u00f4pitaux de Paris Universit\u00e9 Paris Cit\u00e9  Paris France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Fran\u00e7oise","family":"Vendittelli","sequence":"additional","affiliation":[{"name":"AUDIPOG (Association des Utilisateurs de Dossiers informatis\u00e9s en P\u00e9diatrie, Obst\u00e9trique et Gyn\u00e9cologie) RTH Laennec Medical University  Lyon France"},{"name":"Institut Pascal Universit\u00e9 Clermont Auvergne, CHU Clermont\u2010Ferrand, CNRS, SIGMA Clermont  Clermont\u2010Ferrand France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-9367-8317","authenticated-orcid":false,"given":"B\u00e9atrice","family":"Blondel","sequence":"additional","affiliation":[{"name":"Center of Research in Epidemiology and StatisticS (CRESS), Obstetrical Perinatal and Pediatric Epidemiology Research Team (EPOP\u00e9), INSERM, INRA Universit\u00e9 Paris Cit\u00e9  Paris France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8307-6462","authenticated-orcid":false,"given":"Anne Alice","family":"Chantry","sequence":"additional","affiliation":[{"name":"Center of Research in Epidemiology and StatisticS (CRESS), Obstetrical Perinatal and Pediatric Epidemiology Research Team (EPOP\u00e9), INSERM, INRA Universit\u00e9 Paris Cit\u00e9  Paris France"},{"name":"Midiwifery universitary department Universit\u00e9 Paris Cit\u00e9  Paris France"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"name":"the MDN Research Group","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"311","published-online":{"date-parts":[[2024,9,15]]},"reference":[{"key":"e_1_2_13_2_1","volume-title":"Midwifery Unit Standards","author":"Rocca\u2010Ihenacho L","year":"2018"},{"key":"e_1_2_13_3_1","unstructured":"American association of birth centers.Standards for birth 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