It has been a good few weeks since we last saw the publication of a study showing the value of midwife-led care compared to other approaches, so it’s very nice of the BJOG to pop one in their journal to bring a bit of Autumn cheer … or Spring cheer, if you’re in Australia where this study took place.
The study to which I am referring is the latest publication from the COSMOS research team, who have looked at several different questions over the past few years and whose results have been published in a number of other analyses.
What did they find?
Some of the key findings thus far include that:
- midwife-led antenatal care was as effective as usual (which in the case of Australia is generally obstetrician-led) care for women with low-risk pregnancy and better in relation to choice, breast feeding and women׳s experience of care
- in settings with a relatively high baseline caesarean section rate, caseload midwifery for women at low obstetric risk in early pregnancy shows promise for reducing caesarean births
- women allocated to caseload care were admitted to hospital later in labour, and earlier admission was strongly associated with birth by caesarean section, suggesting that remaining at home somewhat longer in labour may be one of the mechanisms by which caseload care was effective in reducing caesarean section in the COSMOS trial
Data from this research project is also included in the Cochrane systematic review on Midwife-led continuity models versus other models of care for childbearing women, which shows that “women who received midwife-led continuity models of care were less likely to experience intervention and more likely to be satisfied with their care with at least comparable adverse outcomes for women or their infants than women who received other models of care”.
Caseload care is also more positive for women
Although previous results from this research project have already (as above) shown midwife-led care to be effective in reducing the caesarean section rate, another important area which the team wanted to look at was the women’s experiences of childbirth. That was the primary focus of this recent paper, and the results show that women who experienced caseload midwifery care “were more positive about their overall birth experience than women in the standard care group (adjusted odds ratio 1.50, 95% CI 1.22–1.84). They also felt more in control during labour, were more proud of themselves, less anxious, and more likely to have a positive experience of pain.” (McLachlan et al 2015)
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McLachlan HL, Forster DA, Davey M-A et al (2015). The effect of primary midwife-led care on women’s experience of childbirth: results from the COSMOS randomised controlled trial. BJOG, online ahead of print.