Table 1 Characteristics of the participation FMUs and OUs

Referral to place of birth

Risk assessment by midwife and general practitioner at all antenatal visits

Risk assessment by midwife and general practitioner at all antenatal visits

Low risk women self-referred to preferred place of birth (home, FMU, OU). Decision could be changed at any time

Low risk women self-referred to preferred place of birth (home, FMU, OU). Decision could be changed at any time

Primary intrapartum care provider

Midwife

Midwife

In case of transfer, the FMU midwife would accompany the women to an OU and if possible, continued care, supervised by an obstetrician.

In case of complications, the OU midwife would continue care, supervised by an obstetrician.

Midwifery staff

Midwives with >2 years of training, working in a team care model. When needed the FMU midwives would assist at the nearest OU if the FMU was not busy.

Midwives with different levels of experience, supervised by consultant midwife. No team care.

All FMU midwives provided antenatal care one day a week for high and low risk women in the area, regardless of the woman’s choice of birthplace

Most OU midwives provided antenatal care one day a week for high and low risk women in the area

OU midwives worked in a combination of 8-hour shifts and 24-hour (on-call) shifts.

The FMU midwives provided intrapartum and out-of-hours post partum care in 24-hour, on-call shifts.

No OU midwives provided post partum care

1–2 FMU midwives provided only antenatal and postnatal care (all women in the area with low risk of post partum complications could be admitted to the postnatal ward).

Care concept

Priority was given to one-to-one care and continuous support in labour. Most women would be cared for by 1(−2) different midwifes during labour.

One-to-one care and continuous support in labour typically not available. Most women would be cared for by 2–3 different midwives during labour

Active encouragement of ambulation, use of different labour positions and use of water and music for pain relief and relaxation.

Ambulation, use of different labour positions, use of water and music for pain relief and relaxation possible but not routinely encouraged.

Amniotomy (<5 cm dilatation) and episiotomy could be performed if considered relevant by the midwife

Amniotomy (>5 cm dilatation) and episiotomy could be performed if considered relevant by the midwife as well as oxytocin augmentation of labour (the latter only on basis of local guidelines).

Cardiotocography (CTG)

Auscultation.

Auscultation.

Admission CTG offered to all women. Transfer performed if CTG indicated

No Admission CTG. CTG only used on indication (including epidural analgesia and oxytocin augmentation)

Assistance for emergencies *

The FMUs were hosted by regional hospitals providing 24-hour emergency, on site assistance from anaesthesiologist (day) / capable specialist nurse (evening + night).

Assistance of obstetrician, anaesthesiologist and paediatrician available 24-hour on site / on site during daytime

All obstetric and paediatric assistance required transfer

Transfer

Ante- and intrapartum referral/transfer to OU on basis of regional, multi-disciplinary guidelines. The FMUs, OUs and ambulance service had well-established routines for ambulance transfer of mother and infant.

OU midwife / consultant midwife/ obstetrician and/or paediatrician would always be contacted by FMU midwife before transfer in order to prepare the admission of the patient.