BACKGROUND:
Global evidence supports midwife continuity of care (MCC), yet its implementation remains limited in many high-income countries. In Belgium, a technocratic maternity system restricts midwifery autonomy despite formal recognition. This study explores the relationship between birth setting and maternal and neonatal outcomes.

OBJECTIVES:
Compare maternal and neonatal outcomes between intramural (hospital/Midwifery-Led Unit) and extramural (home/birth centre) births; examine the influence of sociodemographic and obstetric factors; assess discrepancies between planned and actual birth settings; identify predictors of birth setting and lead caregiver.

METHODS:
Retrospective cohort study using data from 47 midwifery practices in Belgium (2020–2023). Outcomes included perineal trauma, Apgar scores, interventions, and referrals. Logistic, baseline-category and cumulative logit models. Concordance between planned and actual birthplace was assessed with Cohen’s kappa and Stuart-Maxwell test. Multiple imputation addressed missing data.

RESULTS:
Extramural births were associated with fewer interventions: lower odds of episiotomy and of first-, second-, and third-degree perineal tears. Neonatal outcomes were more favorable for extramural births: higher odds of elevated 1-minute and 5-minute Apgar scores, though with modestly increased odds of estimated blood loss and neonatal resuscitation. Sociodemographic factors influenced outcomes and setting choice. Dutch-speaking women had lower odds of significant blood loss than French-speaking women. Married women had over four times higher odds of episiotomy and used upright birthing positions less frequently. Tertiary education increased the likelihood of an extramural birth and use of positions like squatting. Only about half as many planned birth centre births occurred as planned compared to home births, hospital births, and MLUs, where the rate was roughly twice as high.

CONCLUSIONS:
Birth setting and care model are linked to outcomes, though not causally. Tailoring care to social and obstetric context promotes equitable, person-centered maternity care.

KEY MESSAGE:
Extramural births are linked to fewer interventions and better neonatal outcomes. Risk-stratified research is needed to clarify their effects and guide policy. Poster session 1 (Group A)