OBJECTIVES: To evaluate caseload midwifery care in comparison to traditional 'shared care'. DESIGN: Comparative study with area randomisation. SETTING:District general hospital in England. MAIN OUTCOME MEASURES: 'Known carer at delivery,' 'normal vaginal delivery' and 'obstetric intervention'. SUBJECTS:All pregnant women delivering in the six areas chosen for the study. MAIN FINDINGS: A highly significant difference was found between caseload and traditional care groups in terms of level of 'known carer at delivery' (696/770 94.7%; cf. 52/735 (6.7%), p < 0.001). However, no differences in 'normal vaginal delivery' rates were found (542/770 (70%) cf. 509/735 (69%). There were fewer 'obstetric interventions' in the caseload group, particularly epidural analgesia (80/770 (10%) cf. 110/735 (15%) p = 0.01) and oxytocin augmentation (351/77 (46%) cf. 387/735 (53%), p = 0.01). There were no significant differences found in terms of neonatal outcome. CONCLUSIONS: Caseload midwifery results in high levels of 'known carer at delivery' which appears to be associated with a reduction in augmentation and epidural rates but which were not associated with an increase in normal vaginal delivery rate.
RCT Entities:
OBJECTIVES: To evaluate caseload midwifery care in comparison to traditional 'shared care'. DESIGN: Comparative study with area randomisation. SETTING: District general hospital in England. MAIN OUTCOME MEASURES: 'Known carer at delivery,' 'normal vaginal delivery' and 'obstetric intervention'. SUBJECTS: All pregnant women delivering in the six areas chosen for the study. MAIN FINDINGS: A highly significant difference was found between caseload and traditional care groups in terms of level of 'known carer at delivery' (696/770 94.7%; cf. 52/735 (6.7%), p < 0.001). However, no differences in 'normal vaginal delivery' rates were found (542/770 (70%) cf. 509/735 (69%). There were fewer 'obstetric interventions' in the caseload group, particularly epidural analgesia (80/770 (10%) cf. 110/735 (15%) p = 0.01) and oxytocin augmentation (351/77 (46%) cf. 387/735 (53%), p = 0.01). There were no significant differences found in terms of neonatal outcome. CONCLUSIONS: Caseload midwifery results in high levels of 'known carer at delivery' which appears to be associated with a reduction in augmentation and epidural rates but which were not associated with an increase in normal vaginal delivery rate.
Authors: Helen L McLachlan; Della A Forster; Mary-Ann Davey; Judith Lumley; Tanya Farrell; Jeremy Oats; Lisa Gold; Ulla Waldenström; Leah Albers; Mary Anne Biro Journal: BMC Pregnancy Childbirth Date: 2008-08-05 Impact factor: 3.007