Effects of continuity of care by a primary midwife (caseload midwifery) on caesarean section rates in women of low obstetric risk : the COSMOS randomised controlled trial

McLachlan, H. L., Forster, D. A., Davey, M. A., Farrell, T., Gold, L., Biro, M. A., Albers, L., Flood, M., Oats, J. and Waldenstrom, U. 2012, Effects of continuity of care by a primary midwife (caseload midwifery) on caesarean section rates in women of low obstetric risk : the COSMOS randomised controlled trial, BJOG : International journal of obstetrics and gynaecology, vol. 119, pp. 1483-1492.

Attached Files
Name Description MIMEType Size Downloads

Title Effects of continuity of care by a primary midwife (caseload midwifery) on caesarean section rates in women of low obstetric risk : the COSMOS randomised controlled trial
Author(s) McLachlan, H. L.
Forster, D. A.
Davey, M. A.
Farrell, T.
Gold, L.
Biro, M. A.
Albers, L.
Flood, M.
Oats, J.
Waldenstrom, U.
Journal name BJOG : International journal of obstetrics and gynaecology
Volume number 119
Start page 1483
End page 1492
Total pages 10
Publisher Wiley-Blackwell Publshing Ltd
Place of publication Oxford, England
Publication date 2012
ISSN 0140-7686
1471-0528
Keyword(s) caesarean,
randomised controlled trial
continuity of care
continuity of care
caseload midwifery
Summary Objective  To determine whether primary midwife care (caseload midwifery) decreases the caesarean section rate compared with standard maternity care.

Design  Randomised controlled trial.

Setting  Tertiary-care women’s hospital in Melbourne, Australia.

Population  A total of 2314 low-risk pregnant women.

Methods  Women randomised to caseload received antenatal, intrapartum and postpartum care from a primary midwife with some care by ‘back-up’ midwives. Women randomised to standard care received either midwifery or obstetric-trainee care with varying levels of continuity, or community-based general practitioner care.

Main outcome measures  Primary outcome: caesarean birth. Secondary outcomes included instrumental vaginal births, analgesia, perineal trauma, induction of labour, infant admission to special/neonatal intensive care, gestational age, Apgar scores and birthweight.

Results  In total 2314 women were randomised–1156 to caseload and 1158 to standard care. Women allocated to caseload were less likely to have a caesarean section (19.4% versus 24.9%; risk ratio [RR] 0.78; 95% CI 0.67–0.91; P = 0.001); more likely to have a spontaneous vaginal birth (63.0% versus 55.7%; RR 1.13; 95% CI 1.06–1.21; P < 0.001); less likely to have epidural analgesia (30.5% versus 34.6%; RR 0.88; 95% CI 0.79–0.996; P = 0.04) and less likely to have an episiotomy (23.1% versus 29.4%; RR 0.79; 95% CI 0.67–0.92; P = 0.003). Infants of women allocated to caseload were less likely to be admitted to special or neonatal intensive care (4.0% versus 6.4%; RR 0.63; 95% CI 0.44–0.90; P = 0.01). No infant outcomes favoured standard care.

Conclusion  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.
Language eng
Field of Research 111006 Midwifery
Socio Economic Objective 920204 Evaluation of Health Outcomes
HERDC Research category C1 Refereed article in a scholarly journal
Copyright notice ©2012, Wiley-Blackwell Publishing Ltd.
Persistent URL http://hdl.handle.net/10536/DRO/DU:30047104

Document type: Journal Article
Collection: Population Health
Connect to link resolver
 
Unless expressly stated otherwise, the copyright for items in DRO is owned by the author, with all rights reserved.

Versions
Version Filter Type
Citation counts: TR Web of Science Citation Count  Cited 26 times in TR Web of Science
Google Scholar Search Google Scholar
Access Statistics: 97 Abstract Views, 3 File Downloads  -  Detailed Statistics
Created: Mon, 13 Aug 2012, 12:49:32 EST by Jane Moschetti

Every reasonable effort has been made to ensure that permission has been obtained for items included in DRO. If you believe that your rights have been infringed by this repository, please contact drosupport@deakin.edu.au.