BACKGROUND:
In France, innovative alternative midwifery units (AMU) within hospital settings offer personalized care to low-risk pregnant women, with a dedicated midwife during pregnancy and childbirth (non-medicalized birthing room), without supplementary fees.

OBJECTIVES:
To compare women's mode of delivery (spontaneous vaginal versus instrumental /cesarean) in AMUs versus standard obstetric units (SOU), as well as maternal and neonatal outcomes.

METHODS:
PhysioCare was a multicenter prospective cohort study (exposed/unexposed, 1:2 ratio; matched by center and parity), including 600 low-risk pregnant women (196 in AMUs and 404 in SOUs) between 34 and 39 weeks’ gestation, recruited from three French maternity hospitals (September 2022-April 2023). Data were extracted from maternal and neonatal medical records. Multivariate intention-to-treat analyses were performed using IPTW based on propensity scores, adjusting for education level, center, maternal age, parity, and BMI.

RESULTS:
Spontaneous vaginal delivery occurred in 82.1% of women in AMUs versus 79.1% in SOUs (ORa=1.15[0.65, 2.02]). No significant differences were observed in spontaneous labor onset, perineal status (intact/minor tears), or spontaneous placental delivery (ORa=1.17[0.67, 2.06]; ORa=1.43[0.77, 2.66]; ORa=1.42[0.49, 4.13], respectively). Postpartum hemorrhage >500mL was more frequent in AMUs (ORa=2.13[1.01, 4.49]). AMUs showed fewer medical interventions: more labor without oxytocin, with intact/spontaneously ruptured membranes, and without epidural (ORa=3.39[1.99, 5.77]; ORa=3.19[1.86, 5.45]; ORa=15.88[8.88, 28.38], respectively), and fewer intrapartum complications (e.g., fetal heart rate abnormalities, maternal fever, stalled labor). Early postpartum discharges and breastfeeding rates were higher in AMUs (ORa=4.56[2.05, 10.15], ORa=5.52[2.56, 11.90], respectively). No significant differences were observed in neonatal outcomes (e.g., Apgar score ≥7 at 5 minutes, neonatal admission).

CONCLUSIONS:
AMUs show favorable salutogenic outcomes, without increased feto-maternal and neonatal morbidity except for bleeding (to be explored), supporting their continued and expansion to promote safe and personalized care.

KEY MESSAGE:
AMUs provide safe and personalized care for low-risk pregnancies, with fewer interventions and favorable maternal and neonatal outcomes, supporting their expansion in hospital settings. Poster session 2 (Group A)