What is caseload midwifery care

Continuity of carer and satisfaction. What is it about antenatal continuity of caregiver that matters to women? Satisfaction with midwife-managed care in different time periods: a randomised controlled trial of women. Continuity of carer: what matters to women? A review of the evidence.

Freeman LM. Continuity of carer and partnership. A review of the literature. Women Birth. BMC Pregnancy Childbirth. Brown S, Lumley J. Satisfaction with care in labor and birth: a survey of Australian women.

College Station. Texas: StataCorp; STATA, vol. Texas: StataCorp LP; Gupta SK. Intention-to-treat concept: A review. Perspect Clin Res. Melbourne: State Government of Victoria; Births in Victoria and Melbourne: Department of Health; Download references. We gratefully acknowledge the National Health and Medical Research Council for trial funding, the women and midwives who participated in the study; and members of the study Reference Group, the Safety Committee and the Data Monitoring Committee.

We acknowledge the dedicated research midwives and research assistants and the support of the study by hospital management, midwifery and obstetric teams, as well as the Information Technology Department and Health Information Services. Della A. Forster, Helen L. You can also search for this author in PubMed Google Scholar. Correspondence to Della A. All authors made contributions to subsequent drafts and all authors read and approved the final manuscript.

Reprints and Permissions. Forster, D. BMC Pregnancy Childbirth 16, 28 Download citation. Received : 08 July Accepted : 05 January Published : 03 February Anyone you share the following link with will be able to read this content:.

Sorry, a shareable link is not currently available for this article. Provided by the Springer Nature SharedIt content-sharing initiative. Skip to main content. Search all BMC articles Search. Download PDF. Forster 1 , 2 , Helen L. Abstract Background Continuity of care by a primary midwife during the antenatal, intrapartum and postpartum periods has been recommended in Australia and many hospitals have introduced a caseload midwifery model of care. Methods Pregnant women at low risk of complications, booking for care at a tertiary hospital in Melbourne, Australia, were recruited to a randomised controlled trial between September and June Results Two thousand, three hundred fourteen women were randomised: 1, to caseload care and 1, to standard care.

Background Continuity of carer has been strongly recommended and encouraged in maternity services in Australia [ 1 ], and many hospitals have responded by introducing caseload midwifery. Methods Study design and population The study used a two-arm, randomised controlled design, stratified by parity first or subsequent birth , to compare caseload midwifery care with standard maternity care [ 17 ].

Procedures Women were recruited to the study by research midwives when attending their booking visit at the antenatal clinic, and randomised after written consent was obtained and the background questionnaire collecting demographic data completed. Data collection A postal questionnaire was mailed to all women two months after the birth, with the exception of those who had withdrawn, miscarried, had a perinatal death, or if either mother or infant had a serious medical problem.

Measures of continuity Medical record data were obtained to describe intervention exposure. When you are in labour your midwife will discuss when to come into the hospital. Your Caseload midwife will provide care and support to you during labour and birth. If you and your baby are well, you can be discharged home hours after birth.

If you have a medical concern, you will be admitted to the maternity ward. Your caseload midwife will then help you plan for discharge.

Your midwife will visit you and your baby at home following discharge from the hospital. Home visits are provided for up to two weeks following the birth of your baby. Your GP or local child and family health centre will then provide care for you and your baby. Source and reference attributes. Getting started: what is midwifery continuity of care? Chatswood: Elsevier Australia, Relational attributes.

All analyses of outcomes are presented separately for nulliparous and multiparous women. In the main analysis, we used inferential statistics Chi square; two-sided t-test to compare the outcomes for women in caseload care and regular care. To capture the differences between intrapartum care in caseload and regular practices, we performed an exploratory sub-analysis among low risk women who started labour in midwife-led care.

Given these exclusions, we could no longer use our matching procedure; for this reason we used only descriptive statistics percentages to illustrate the differences between the two groups. We identified 33 midwives that fulfilled the description of caseload midwifery care. Among them 23 had a LVR1 practice registration number in , individually or together with other caseload midwives.

Six midwives started practice registration in , and another four did not provide a practice registration number.

These 10 were excluded from the study. Of these women, we included all women that were registered by caseload midwives in our study. The matched cohort contained women in regular midwifery care. If the matching procedure had been fully successful, the matched cohort would have contained controls. All cases had at least one exact match.

Women in caseload care were slightly older mean These and other characteristics are shown in Table 1. After matching for parity, age and background, women in caseload care showed some differences in other demographic characteristics with the women in regular care.

They more often lived in a neighbourhood with a higher SES Other characteristics seem to confirm that women in caseload care are a distinct group. They more often opted for a home birth Gestational age at birth was slightly higher This suggests that they more often opted for expectant management in case of a prolonged pregnancy, despite existing recommendations in the Netherlands [ 29 ]. Outcomes of women in caseload care were compared to the matched cohort Table 2.

A small majority The overall referral rate was A lower referral rate was observed both in the antenatal period and in the intrapartum period, for nulliparous and for multiparous women. In the antenatal period, Mode of birth also differed between women in caseload care and in the matched cohort p -value 0. Women in caseload care more often Women in caseload care were more likely to experience a spontaneous start of labour They were less often induced A similar pattern existed for nulliparous and multiparous women.

The place of birth was also different p-value 0. A larger proportion of women in caseload care had an out-of-hospital birth More multiparous women than nulliparous women had an out-of-hospital birth, both in caseload practices and in regular care. The larger proportion of hospital births in obstetrician-led care in regular care This difference was not statistically significant p -value 0.

Fewer women in caseload care experienced an episiotomy There was no significant difference in 3rd or 4th degree perineal ruptures 2. Nulliparous women were more likely to experience perineal damage compared to multiparous women, both in the caseload group and in the matched cohort.

Unfavourable perinatal outcomes were rare in both groups. Perinatal mortality occurred in one case 0. These differences were not statistically significant. We excluded 39 7. As a result of this selection of women without known risk factors at the start of term labour, the groups are no longer matched and the results should be interpreted with caution. Results are displayed in Table 3.

In this sub-analysis the lower intrapartum referral rate in caseload care among nulliparous women Both nulliparous and multiparous women in caseload care experienced fewer interventions during labour, and more often had a spontaneous vaginal birth. As in the main analysis, maternal morbidity was lower in the caseload group. Our study shows that in the Netherlands, when compared with regular midwife-led care, caseload midwife-led care was associated with considerably fewer referrals to obstetrician-led care — both antenatally and in the intrapartum period — and with more spontaneous vaginal births.

These results were found for both nulliparous and multiparous women. Furthermore, we observed fewer interventions during labour and birth and less maternal morbidity in caseload midwifery care.

The incidence of perinatal mortality or a low Apgar score were low in both groups. The main challenge in this comparison of results from caseload care and regular midwife-led care is the comparability of women in both groups. Several factors may still cause differences in risk profiles, although our matching procedure successfully minimized confounding by parity, age, or background.

To control for regional variation in interventions we added the first two digits of the postal code in the matching procedure. Because our measure for SES and urbanization both are based on the postal code as well, we chose not to match on these variables. Based on the somewhat higher SES in the caseload group compared to the matched controls in regular care, a slightly more favorable risk profile cannot be ruled out. We could also not describe, nor control for, risk factors such as obesity, smoking or other life style factors since these are not reliably registered in the Perined database.

Therefore, we assume that the risk profiles of the caseload group and the matched cohort are not very different and do not lead to important bias. Nevertheless, women in caseload care may be different from women in regular care in other important ways that cannot easily be assessed.

The observed characteristics confirm that women in caseload care are a distinct group, with a higher than average motivation for a physiological birth, including homebirth and expectant management in prolonged pregnancy beyond 42 gestational weeks.

Seeking the care of a caseload midwife may be a part of this inclination [ 25 ]. It is not possible to assess to what extent these preferences resulted in continuation of primary care or opting for homebirths in situations that usually lead to referral to secondary care in the hospital.

Altogether, the lower referral and intervention rate we found will at least partly be a result of specific preferences among this group of women. The study is too small for a reliable comparison in perinatal mortality or serious perinatal morbidity, since these outcomes are rare.

At the same time, our results do not suggest that perinatal safety is compromised in caseload care: percentages of both perinatal mortality and low Apgar scores in the caseload and control groups in the caseload and control groups were similar.

In a larger, preferably prospective, study it would be interesting to analyze perinatal results with the possibility to control for several risk factors including maternal lifestyle and to audit cases with severe perinatal morbidity or mortality.

While our study has certain methodological limitations — e. For instance, randomized trials [ 1 , 2 , 30 , 31 ] showed no differences in neonatal outcomes such as low Apgar scores or admission to neonatal intensive care.

A meta-analysis showed a higher spontaneous vaginal birth rate in caseload midwifery care [ 3 ]. Observational studies of caseload midwifery in various settings consistently show fewer interventions during childbirth, without compromising perinatal safety [ 32 , 33 , 34 , 35 ].

We were not able to assess the level of one-to-one continuity of care in the caseload group because this information is not available in the Perined database. However, we are confident that the majority of the caseload clients received a high level of continuity of care throughout pregnancy and childbirth. In the inclusion procedure, participating midwives confirmed that they remained involved in the care when antenatal obstetric consultation or referral was needed, and all offered continuity of care during labour, even when there was an intrapartum referral.

Most of them also inform women of this service on their practice website. Fontein [ 26 ] observed a similar pattern in practices with one or two midwives, where continuity of care was higher, and the midwife-woman relationship was experienced more positively when compared to group practices.

Fontein et al. Such relationships are more likely to evolve in continuity models than in fragmented care offered in busy institutions or by large midwifery teams [ 38 ].