Characteristics of the maternity units and perinatal management among low-risk women in France
In France, most of women are considered at low-risk. If medicalization of pregnancy and delivery is relevant in high risk women, it is different in the low risk obstetrical context. In these situations, over-medicalization could be iatrogenic for women and their infants. Our hypothesis was that the management of low-risk pregnancies varied according to facilities. In low-risk women, we evaluated the association between characteristics of maternity units and medicalization in the perinatal period, through 4 medical interventions; caesarean during labour, elective induction, admission to neonatal care unit and epidural analgesia. Level 2 and 3 maternity units were associated with an increased risk of caesarean during labour and an increased risk of admission in neonatal care unit. There was an association between size and status of the maternity units and realization of an elective induction. Finally, the reported choice to give birth without epidural analgesia appeared associated with the organization of the maternity units. Theoretically, only medical condition should guide decisions to perform interventions in low-risk women, without influence of the characteristics of the maternity units and physicians should adapt their practices according to the level of risk of their patient. The diffusion of our results might help them to become conscious that over-medicalization could be harmful in low-risk women.