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Hjorth S, Brülle AL, Kristensen H, Frederiksen A, Nohr EA. Labor outcomes in caseload midwifery compared with standard midwifery care: A cohort study. Birth 2024. [PMID: 39140615 DOI: 10.1111/birt.12861] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Revised: 02/09/2024] [Accepted: 07/24/2024] [Indexed: 08/15/2024]
Abstract
BACKGROUND Research has shown caseload midwifery to increase the chance of vaginal birth, but this may not be the case in settings with high vaginal birth rates in standard care. This study investigated the association between caseload midwifery and birth mode, labor interventions, and maternal and neonatal outcomes at a large obstetric unit in Denmark. METHODS Cohort study including medical records on live, singleton births fr om June 2018 until February 2022. Exposure was caseload midwifery care compared with standard midwifery care. The primary outcome was birth mode, and secondary outcomes were other outcomes of labor. Adjusted risk ratios (aRR) with 95% confidence intervals (CI) were estimated by log-binomial regression. RESULTS Among 16,110 pregnancies, 3162 pregnancies (19.6%) received caseload midwifery care. Caseload midwifery was associated with fewer planned cesareans (aRR 0.63 [95% CI 0.54-0.74]) and emergency cesareans (aRR 0.86 [95% CI 0.75-0.95]). No differences in labor induction, use of epidural analgesia, oxytocin augmentation, or anal sphincter tears were observed. Caseload midwifery performed more amniotomies (aRR 1.14 [95% CI 1.02-1.27]) and tended to perform more episiotomies (aRR 1.19 [95% CI 0.96-1.48]). Postpartum hemorrhage (aRR 0.90 [95% CI 0.82-0.99]) and low Apgar score were less likely (aRR 0.54 [95% CI 0.37-0.77]), and early discharge more likely (aRR 1.22 [95% CI 1.17-1.28]) in caseload midwifery. CONCLUSION In caseload midwifery care, a higher vaginal birth rate was observed with no increase in adverse outcomes, mainly due to a lower likelihood of planned cesarean. Also, fewer children were born with low Apgar scores.
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Affiliation(s)
- Sarah Hjorth
- Department of Gynaecology and Obstetrics, Odense University Hospital, Odense, Denmark
- Research Unit for Gynecology and Obstetrics, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
| | - Anne-Line Brülle
- Department of Gynaecology and Obstetrics, Odense University Hospital, Odense, Denmark
| | - Helle Kristensen
- Department of Gynaecology and Obstetrics, Odense University Hospital, Odense, Denmark
| | - Anette Frederiksen
- Department of Gynaecology and Obstetrics, Odense University Hospital, Odense, Denmark
| | - Ellen Aagard Nohr
- Department of Gynaecology and Obstetrics, Odense University Hospital, Odense, Denmark
- Research Unit for Gynecology and Obstetrics, Department of Clinical Research, University of Southern Denmark, Odense, Denmark
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Hoxha I, Grezda K, Udutha A, Taganoviq B, Agahi R, Brajshori N, Rising SS. Systematic review and meta-analysis examining the effects of midwife care on cesarean birth. Birth 2024; 51:264-274. [PMID: 38037256 DOI: 10.1111/birt.12801] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2020] [Accepted: 10/27/2023] [Indexed: 12/02/2023]
Abstract
BACKGROUND The increasing number of unnecessary cesarean births is a cause for concern and may be addressed by increasing access to midwifery care. The objective of this review was to assess the effect of midwifery care on the likelihood of cesarean births. METHODS We searched five databases from the beginning of records through May 2020. We included observational studies that reported odds ratios or data allowing the calculation of odds ratios of cesarean birth for births with and without midwife involvement in care or presence at the institution. Standard inverse-variance random-effects meta-analysis was used to generate overall odds ratios (ORs). RESULTS We observed a significantly lower likelihood of cesarean birth in midwife-led care, midwife-attended births, among those who received instruction pre-birth from midwives, and within institutions with a midwifery presence. CONCLUSIONS Care from midwives reduces the likelihood of cesarean birth in all the analyses, perhaps due to their greater preference and skill for physiologic births. Increased use of midwives in maternal care can reduce cesarean births and should be further researched and implemented broadly, potentially as the default modality in maternal care.
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Affiliation(s)
- Ilir Hoxha
- The Dartmouth Institute for Health Policy and Clinical Practice, Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire, USA
- Kolegji Heimerer, Prishtina, Kosovo
- Evidence Synthesis Group, Prishtina, Kosovo
| | | | - Anirudh Udutha
- Geisel School of Medicine at Dartmouth, Lebanon, New Hampshire, USA
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Behboudi-Gandevani S, Bidhendi-Yarandi R, Hossein Panahi M, Mardani A, Prinds C, Vaismoradi M, Glarcher M. Prevalence of preterm birth in Scandinavian countries: a systematic review and meta-analysis. J Int Med Res 2023; 51:3000605231203843. [PMID: 37843530 PMCID: PMC10683576 DOI: 10.1177/03000605231203843] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 09/11/2023] [Indexed: 10/17/2023] Open
Abstract
OBJECTIVES As welfare societies, Scandinavian countries share characteristics of equality related to healthcare access, gender, and social services. However, cultural and lifestyle variations create country-specific health differences. This meta-analysis assessed the prevalence of preterm birth (PTB) and its categories in Scandinavian countries. METHODS A systematic search in key databases of literature published between 1990 and 2021 identified studies of the prevalence of PTB and its categories. Following the use of the Freeman-Tukey double arcsine transformation, a meta-analysis of weighted data was performed using the random-effects model and meta-prop method. RESULTS We identified 109 observational studies that involved 86,420,188 live births. The overall pooled prevalence (PP) of PTB was 5.3% (PP = 5.3%, 95% confidence interval [CI] 5.1%, 5.5%). The highest prevalence was in Norway (PP = 6.2%, 95% CI 5.3%, 7.0%), followed by Sweden (PP = 5.3%, 95% CI 5.1%, 5.4%), Denmark (PP = 5.2%, 95% CI 4.9%, 5.3%), and Iceland (PP = 5.0%, 95% CI 4.4%, 5.7%). Finland had the lowest PTB rate (PP = 4.9%, 95% CI 4.7%, 5.1%). CONCLUSIONS The overall PP of PTB was 5.3%, with small variations among countries (4.9%-6.2%). The highest and lowest PPs of PTB were in Norway and Finland, respectively.
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Affiliation(s)
| | - Razieh Bidhendi-Yarandi
- Department of Biostatistics and Epidemiology, School of Social Health, University of Social Welfare and Rehabilitation Sciences, Tehran, Iran
| | - Mohammad Hossein Panahi
- Department of Epidemiology, School of Public Health and Safety, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Abbas Mardani
- Nursing and Midwifery Care Research Center, School of Nursing and Midwifery, Iran University of Medical Sciences, Tehran, Iran
| | - Christina Prinds
- Department of Clinical Research, University South Denmark, Odense, Denmark; Department of Women’s Health, University Hospital of Southern Denmark, Esbjerg, Denmark
| | - Mojtaba Vaismoradi
- Faculty of Nursing and Health Sciences, Nord University, Bodø, Norway
- Faculty of Science and Health, Charles Sturt University, Orange, NSW, Australia
| | - Manela Glarcher
- Institute of Nursing Science and Practice, Paracelsus Medical University, Salzburg, Austria
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Wassén L, Borgström Bolmsjö B, Frantz S, Hagman A, Lindroth M, Rubertsson C, Strandell A, Svanberg T, Wessberg A, Wallerstedt SM. Child and maternal benefits and risks of caseload midwifery - a systematic review and meta-analysis. BMC Pregnancy Childbirth 2023; 23:663. [PMID: 37715118 PMCID: PMC10504769 DOI: 10.1186/s12884-023-05967-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2022] [Accepted: 08/31/2023] [Indexed: 09/17/2023] Open
Abstract
BACKGROUND It has been reported that caseload midwifery, which implies continuity of midwifery care during pregnancy, childbirth, and the postnatal period, improves the outcomes for the mother and child. The aim of this study was to review benefits and risks of caseload midwifery, compared with standard care comparable to the Swedish setting where the same midwife usually provides antenatal care and the checkup postnatally, but does not assist during birth and the first week postpartum. METHODS Medline, Embase, Cinahl, and the Cochrane Library were searched (Nov 4th, 2021) for randomized controlled trials (RCTs). Retrieved articles were assessed and pooled risk ratios calculated when possible, using random-effects meta-analyses. Certainty of evidence was assessed according to GRADE. RESULTS In all, 7,594 patients in eight RCTs were included, whereof five RCTs without major risk of bias, including 5,583 patients, formed the basis for the conclusions. There was moderate certainty of evidence for little or no difference regarding the risk of Apgar ≤ 7 at 5 min, instrumental birth, and preterm birth. There was low certainty of evidence for little or no difference regarding the risk of perinatal mortality, neonatal intensive care, perineal tear, bleeding, and acute caesarean section. Caseload midwifery may reduce the overall risk of caesarean section. Regarding breastfeeding after hospital discharge, maternal mortality, maternal morbidity, health-related quality of life, postpartum depression, health care experience/satisfaction and confidence, available studies did not allow conclusions (very low certainty of evidence). For severe child morbidity and Apgar ≤ 4 at 5 min, there was no literature available. CONCLUSIONS When caseload midwifery was compared with models of care that resembles the Swedish one, little or no difference was found for several critical and important child and maternal outcomes with low-moderate certainty of evidence, but the risk of caesarean section may be reduced. For several outcomes, including critical and important ones, studies were lacking, or the certainty of evidence was very low. RCTs in relevant settings are therefore required.
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Affiliation(s)
- Lotta Wassén
- Department of Obstetrics and Gynecology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Beata Borgström Bolmsjö
- Department Research and education, HTA syd, Skåne University Hospital, Lund, Sweden
- Department of Clinical Sciences Malmö, Lund University, Malmö, Sweden
| | - Sophia Frantz
- Department Research and education, HTA syd, Skåne University Hospital, Lund, Sweden
- Clinical Physiology and Nuclear Medicine Unit, Department of Translational Medicine, Lund University, Malmö, Malmö, Sweden
| | - Anna Hagman
- Regional Healthcare, Region Västra Götaland, Gothenburg, Sweden
| | - Marie Lindroth
- Midwifery Clinic in Primary Care, Region Skåne, Malmö, Sweden
| | | | - Annika Strandell
- Department of Obstetrics and Gynecology, Sahlgrenska University Hospital, Gothenburg, Sweden
- HTA-centrum, Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden
| | - Therese Svanberg
- Medical library, Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden
| | - Anna Wessberg
- Department of Obstetrics and Gynecology, Sahlgrenska University Hospital, Gothenburg, Sweden
| | - Susanna M Wallerstedt
- HTA-centrum, Sahlgrenska University Hospital, Region Västra Götaland, Gothenburg, Sweden.
- Department of Pharmacology, Sahlgrenska Academy, University of Gothenburg, Box 431, Gothenburg, SE-405 30, Sweden.
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Gao P, Guo CQ, Chen MY, Zhuang HP. Nursing model of midwifery and postural and psychological interventions: Impact on maternal and fetal outcomes and negative emotions of primiparas. World J Psychiatry 2023; 13:543-550. [PMID: 37701545 PMCID: PMC10494776 DOI: 10.5498/wjp.v13.i8.543] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2023] [Revised: 06/28/2023] [Accepted: 07/14/2023] [Indexed: 08/17/2023] Open
Abstract
BACKGROUND Primiparas are usually at high risk of experiencing perinatal depression, which may cause prolonged labor, increased blood loss, and intensified pain, affecting maternal and fetal outcomes. Therefore, interventions are necessary to improve maternal and fetal outcomes and alleviate primiparas' negative emotions (NEs). AIM To discusses the impact of nursing responsibility in midwifery and postural and psychological interventions on maternal and fetal outcomes as well as primiparas' NEs. METHODS As participants, 115 primiparas admitted to Quanzhou Maternity and Child Healthcare Hospital between May 2020 and May 2022 were selected. Among them, 56 primiparas (control group, Con) were subjected to conventional midwifery and routine nursing. The remaining 59 (research group, Res) were subjected to the nursing model of midwifery and postural and psychological interventions. Both groups were comparatively analyzed from the perspectives of delivery mode (cesarean, natural, or forceps-assisted), maternal and fetal outcomes (uterine inertia, postpartum hemorrhage, placental abruption, neonatal pulmonary injury, and neonatal asphyxia), NEs (Hamilton Anxiety/Depression-rating Scale, HAMA/HAMD), labor duration, and nursing satisfaction. RESULTS The Res exhibited a markedly higher natural delivery rate and nursing satisfaction than the Con. Additionally, the Res indicated a lower incidence of adverse events (e.g., uterine inertia, postpartum hemorrhage, placental abruption, neonatal lung injury, and neonatal asphyxia) and shortened duration of various stages of labor. It also showed statistically lower post-interventional HAMA and HAMD scores than the Con and pre-interventional values. CONCLUSION The nursing model of midwifery and postural and psychological interventions increase the natural delivery rate and reduce the duration of each labor stage. These are also conducive to improving maternal and fetal outcomes and mitigating primiparas' NEs and thus deserve popularity in clinical practice.
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Affiliation(s)
- Ping Gao
- Department of Obstetrics and Gynecology, Quanzhou Maternity and Child Healthcare Hospital, Quanzhou 362017, Fujian Province, China
- School of Nursing, Fujian Medical University, Quanzhou 350108, Fujian Province, China
| | - Cai-Qiong Guo
- Department of Obstetrics and Gynecology, Quanzhou Maternity and Child Healthcare Hospital, Quanzhou 362017, Fujian Province, China
| | - Ma-Yu Chen
- Department of Obstetrics and Gynecology, Quanzhou Maternity and Child Healthcare Hospital, Quanzhou 362017, Fujian Province, China
| | - Hui-Ping Zhuang
- Department of Obstetrics and Gynecology, The 910th Hospital of the People's Liberation Army Joint Logistic Support Force, Quanzhou 362008, Fujian Province, China
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Zhang Y, Xu K, Gong L, Sun Y, Ren F. The effect of continuous midwifery services on the delivery mode, labor progress, and nursing satisfaction of primiparas during natural deliveries. Am J Transl Res 2021; 13:7249-7255. [PMID: 34306489 PMCID: PMC8290655] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 03/10/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE To analyze the effect of continuous midwifery services on the delivery mode, labor progress, and primiparas' nursing satisfaction levels during natural deliveries. METHODS 340 primiparas admitted to our hospital from January 2017 to June 2020 were recruited as the study cohort and randomized into a continuous midwifery group and a traditional midwifery group, with 170 patients in each group. They underwent traditional midwifery nursing services and continuous midwifery services, respectively. The two groups' delivery modes, labor progress, analgesic methods, perinatal Self-Rating Anxiety Scale (SAS) scores, postpartum hemorrhage amounts, Apgar scores, and nursing satisfaction levels were compared. RESULTS The natural delivery rate in the continuous midwifery group was higher than it was in the traditional midwifery group (P<0.05). The maternal non-drug analgesia rate in the continuous midwifery group was higher than it was in the traditional midwifery group (P<0.05). The duration of the first stage in the continuous midwifery group was shorter than it was in the traditional midwifery group (P<0.05). The comparisons made during the second and third stages in the two groups showed no statistical differences (P>0.05). The SAS scores in the continuous midwifery group were significantly better than the SAS scores in the traditional midwifery group at the time of waiting for delivery and at one day after delivery (P<0.01). The postpartum hemorrhage amounts in the continuous midwifery group were lower than they were in the traditional midwifery group (P<0.01). The neonatal Apgar scores and maternal nursing satisfaction levels in the continuous midwifery group were better than they were in the traditional midwifery group (P<0.01). CONCLUSION Continuous delivery services for primiparas during natural delivery can significantly increase the natural delivery rate, reduce the use of analgesics, shorten the delivery times, alleviate the delivery-related anxiety levels in the primiparas, reduce postpartum hemorrhages, effectively improve the delivery outcomes, improve the quality of the newborns, and improve the primiparas' nursing satisfaction levels, so it is worthy of clinical promotion and application.
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Affiliation(s)
- Yali Zhang
- Department of Obstetrics, Maternity and Child Health Care of Zaozhuang Zaozhuang 277000, Shandong Province, China
| | - Kun Xu
- Department of Obstetrics, Maternity and Child Health Care of Zaozhuang Zaozhuang 277000, Shandong Province, China
| | - Li Gong
- Department of Obstetrics, Maternity and Child Health Care of Zaozhuang Zaozhuang 277000, Shandong Province, China
| | - Yunjia Sun
- Department of Obstetrics, Maternity and Child Health Care of Zaozhuang Zaozhuang 277000, Shandong Province, China
| | - Fenfen Ren
- Department of Obstetrics, Maternity and Child Health Care of Zaozhuang Zaozhuang 277000, Shandong Province, China
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Offerhaus P, Jans S, Hukkelhoven C, de Vries R, Nieuwenhuijze M. Women's characteristics and care outcomes of caseload midwifery care in the Netherlands: a retrospective cohort study. BMC Pregnancy Childbirth 2020; 20:517. [PMID: 32894082 PMCID: PMC7487921 DOI: 10.1186/s12884-020-03204-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2019] [Accepted: 08/21/2020] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND The maternity care system in the Netherlands is well known for its support of community-based midwifery. However, regular midwifery practices typically do not offer caseload midwifery care - one-to-one continuity of care throughout pregnancy and birth. Because we know very little about the outcomes for women receiving caseload care in the Netherlands, we compared caseload care with regular midwife-led care, looking at maternal and perinatal outcomes, including antenatal and intrapartum referrals to secondary (i.e., obstetrician-led) care. METHODS We selected 657 women in caseload care and 1954 matched controls (women in regular midwife-led care) from all women registered in the Dutch Perinatal Registry (Perined) who gave birth in 2015. To be eligible for selection the women had to be in midwife-led antenatal care beyond 28 gestational weeks. Each woman in caseload care was matched with three women in regular midwife-led care, using parity, maternal age, background (Dutch or non-Dutch) and region. These two cohorts were compared for referral rates, mode of birth, and other maternal and perinatal outcomes. RESULTS In caseload midwifery care, 46.9% of women were referred to obstetrician-led care (24.2% antenatally and 22.8% in the intrapartum period). In the matched cohort, 65.7% were referred (37.4% antenatally and 28.3% in the intrapartum period). In caseload care, 84.0% experienced a spontaneous vaginal birth versus 77.0% in regular midwife-led care. These patterns were observed for both nulliparous and multiparous women. Women in caseload care had fewer inductions of labour (13.2% vs 21.0%), more homebirths (39.4% vs 16.1%) and less perineal damage (intact perineum: 41.3% vs 28.2%). The incidence of perinatal mortality and a low Apgar score was low in both groups. CONCLUSIONS We found that when compared to regular midwife-led care, caseload midwifery care in the Netherlands is associated with a lower referral rate to obstetrician-led care - both antenatally and in the intrapartum period - and a higher spontaneous vaginal birth rate, with similar perinatal safety. The challenge is to include this model as part of the current effort to improve the quality of Dutch maternity care, making caseload care available and affordable for more women.
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Affiliation(s)
- Pien Offerhaus
- Research Centre for Midwifery Science, Midwifery Education and Studies Maastricht, ZUYD University, Universiteitssingel 60, 6229 ER Maastricht, the Netherlands
| | - Suze Jans
- TNO, Department of Child Health, Schipholweg 77, 2316 ZL Leiden, The Netherlands
| | | | - Raymond de Vries
- Research Centre for Midwifery Science, Midwifery Education and Studies Maastricht, ZUYD University, Universiteitssingel 60, 6229 ER Maastricht, the Netherlands
- CAPHRI (School for Public Health and Primary Care), Maastricht University, PO Box 616, 6200 MD Maastricht, the Netherlands
- Center for Bioethics and Social Sciences in Medicine, University of Michigan Medical School, 2800 Plymouth Road, Building 14, CBSSM, Ann Arbor, MI 48109-2800 USA
| | - Marianne Nieuwenhuijze
- Research Centre for Midwifery Science, Midwifery Education and Studies Maastricht, ZUYD University, Universiteitssingel 60, 6229 ER Maastricht, the Netherlands
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Merz WM, Tascon-Padron L, Puth MT, Heep A, Tietjen SL, Schmid M, Gembruch U. Maternal and neonatal outcome of births planned in alongside midwifery units: a cohort study from a tertiary center in Germany. BMC Pregnancy Childbirth 2020; 20:267. [PMID: 32375692 PMCID: PMC7201515 DOI: 10.1186/s12884-020-02962-4] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2019] [Accepted: 04/21/2020] [Indexed: 02/03/2023] Open
Abstract
Background For healthy women entering birth after uneventful pregnancy, midwife-led models of care have the potential to reduce interventions and increase the vaginal birth rate. In Germany, 98.4% of women are giving birth in consultant-led obstetric units. Alongside midwifery units (AMU) have been established in 2003. We compared the outcome of women registered for planned birth in the AMU at our hospital with a matched group of low-risk women who gave birth in standard obstetric care during the same period of time. Methods We used a retrospective cohort study design. The study group consisted of all women admitted to labor ward who had registered for birth in AMU from 2010 to 2017. For the control group, low-risk women were selected; additionally, matching was performed for parity. Mode of birth was chosen as primary outcome parameter for the mother. For the neonate, a composite primary outcome (5-min Apgar < 7 or umbilical cord arterial pH < 7.10 or transfer to specialist neonatal care) was defined. Secondary outcomes included epidural anesthesia, duration of the second stage of labor, episiotomy, obstetric injury, and postpartum hemorrhage. Non-inferiority was assessed, and multiple logistic regression analysis was performed. Results Six hundred twelve women were admitted for labor in AMU, the control group consisted of 612 women giving birth in standard obstetric care. Women in the study group were on average older and had a higher body mass index (BMI); birthweight was on average 95 g higher. Non-inferiority could be established for the primary outcome parameters. Epidural anesthesia and episiotomy rates were lower, and the mean duration of the second stage of labor was shorter in the study group; second-degree perineal tears were less common, higher-order obstetric lacerations occurred more frequently. Overall, 50.3% of women were transferred to standard obstetric care. Regression analysis revealed effects of parity, age and birthweight on the chance of transfer. Conclusion Compared to births in our consultant-led obstetric unit, the outcome of births planned in the AMU was not inferior, and intervention rates were lower. Our results support the integration of AMU as a complementary model of care for low-risk women.
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Affiliation(s)
- Waltraut M Merz
- Department of Obstetrics and Prenatal Medicine, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Laura Tascon-Padron
- Department of Obstetrics and Prenatal Medicine, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany.
| | - Marie-Therese Puth
- Department of Medical Biometry, Informatics and Epidemiology, Faculty of Medicine, University of Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Andrea Heep
- Department of Obstetrics and Prenatal Medicine, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Sophia L Tietjen
- Department of Obstetrics and Prenatal Medicine, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Matthias Schmid
- Department of Medical Biometry, Informatics and Epidemiology, Faculty of Medicine, University of Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
| | - Ulrich Gembruch
- Department of Obstetrics and Prenatal Medicine, University Hospital Bonn, Venusberg-Campus 1, 53127, Bonn, Germany
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Hildingsson I, Karlström A, Rubertsson C, Larsson B. Birth outcome in a caseload study conducted in a rural area of Sweden-a register based study. SEXUAL & REPRODUCTIVE HEALTHCARE 2020; 24:100509. [PMID: 32220783 DOI: 10.1016/j.srhc.2020.100509] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Revised: 03/11/2020] [Accepted: 03/19/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Continuity models of midwifery care are rare in Sweden, despite its well-known positive effects. The aim was to describe pregnancy and birth outcome in women participating in a continuity of care project in a rural area of Sweden. METHOD A register-based study of 266 women recruited to the project and a control group of 125 women from the same catchment area. Midwives provided antenatal care and were on-call 7 a.m. to 11 p.m. for birth. Data were collected from the antenatal and birth records. Crude and adjusted odds ratios with 95% confidence intervals were calculated between women in the project and the control group. RESULTS There were more primiparous women and highly educated women recruited to the project, and fewer foreign-born and single women, compared to the control group. Women in the project met more midwives and were less likely to have a pregnancy complication. During intrapartum care, women recruited to the project were less likely to need labour augmentation and less likely to have an instrumental vaginal birth and elective caesarean section. They had fewer second degree perineal tears and were more likely to fully breastfeed at discharge. No differences were found in neonatal outcome. The continuity of a known midwife at birth was quite low. CONCLUSION This study shows that women self-recruited to a continuity of care project in a rural area of Sweden had a higher rate of normal births. There were few differences if having a known midwife or not. Long distances to hospital and lack of staff affected the level of continuity.
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Affiliation(s)
- Ingegerd Hildingsson
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden; Department of Nursing, Mid Sweden University, Sundsvall, Sweden.
| | | | - Christine Rubertsson
- Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden; Department of Nursing, Lund University, Lund, Sweden
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A modified caseload midwifery model for women with fear of birth, women's and midwives' experiences: A qualitative study. SEXUAL & REPRODUCTIVE HEALTHCARE 2020; 24:100504. [PMID: 32120329 DOI: 10.1016/j.srhc.2020.100504] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2019] [Revised: 02/10/2020] [Accepted: 02/23/2020] [Indexed: 01/18/2023]
Abstract
OBJECTIVE Although fear of birth is common during pregnancy and childbirth, the best treatment for fear of birth in clinical care remain unclear. Strong evidence suggests that continuity models of midwifery care can benefit women and birth outcomes, though such models are rare in Sweden. Because women with fear of birth could benefit from such models, the aim of this qualitative study was to examine how women with fear of birth and their midwives experienced care in a modified caseload midwifery model. METHODS A qualitative interview study using thematic analysis. Participants were recruited from a pilot study in which women assessed to have fear of birth received antenatal and intrapartum care, from a midwife whom they knew. Eight women and four midwives were interviewed. RESULTS An overarching theme-"A mutual relationship instilled a sense of peace and security"-and three themes-"Closeness, continuity, and trust," "Preparation and counselling," and "Security, confidence, and reduced fear"-reflect the views and experiences of women with fear of birth and their midwives after participating in a modified caseload midwifery model. CONCLUSIONS For both women with fear of birth and their midwives, the caseload midwifery model generated trustful woman-midwife relationships, which increased women's confidence, reduced their fear, and contributed to their positive birth experiences. Moreover, the midwives felt better equipped to address women's needs, and their way of working with the women became more holistic. Altogether, offering a continuity model of midwifery care could be an option to support women with fear of birth.
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