Labour outcomes in caseload midwifery and standard care: A register-based cohort study

Ingrid Jepsen*, Svend Juul, Maralyn Jean Foureur, Erik Elgaard Sørensen, Ellen Aagaard Nohr

*Corresponding author for this work

Research output: Contribution to journalJournal articleResearchpeer-review

138 Downloads (Pure)

Abstract

Background: Research on caseload midwifery in a Danish setting is missing. This cohort study aimed to compare labour outcomes in caseload midwifery and standard midwifery care. Methods: A historical register-based cohort study was carried out using routinely collected data about all singleton births 2013-2016 in two maternity units in the North Denmark Region. In this region, women are geographically allocated to caseload midwifery or standard care, as caseload midwifery is only available in some towns in the peripheral part of the uptake areas of the maternity units, and it is the only model of care offered here. Labour outcomes of 2679 all-risk women in caseload midwifery were compared with those of 10,436 all-risk women in standard midwifery care using multivariate linear and logistic regression analyses. Results: Compared to women in standard care, augmentation was more frequent in caseload women (adjusted odds ratio (aOR) 1.20; 95% CI 1.06-1.35) as was labour duration of less than 10 h (aOR 1.26; 95% CI 1.13-1.42). More emergency caesarean sections were observed in caseload women (aOR 1.17; 95% CI 1.03-1.34), but this might partly be explained by longer distance to the maternity unit in caseload women. When caseload women were compared to women in standard care with a similar long distance to the hospital, no difference in emergency caesarean sections was observed (aOR 1.04; 95% CI 0.84-1.28). Compared to standard care, infants of caseload women more often had Apgar ≤7 after 5 min. (aOR 1.57; 95% CI 1.11-2.23) and this difference remained when caseload women were compared to women with similar distance to the hospital. For elective caesarean sections, preterm birth, induction of labour, dilatation of cervix on admission, amniotomy, epidural analgesia, and instrumental deliveries, we did not obseve any differences between the two groups. After birth, caseload women more often experienced no laceration (aOR 1.17; 95% CI 1.06-1.29). Conclusions: For most labour outcomes, there were no differences across the two models of midwifery-led care but unexpectedly, we observed slightly more augmentation and adverse neonatal outcomes in caseload midwifery. These findings should be interpreted in the context of the overall low intervention and complication rates in this Danish setting and in the context of research that supports the benefits of caseload midwifery. Although the observational design of the study allows only cautious conclusions, this study highlights the importance of monitoring and evaluating new practices contextually.

Original languageEnglish
Article number2090
JournalBMC Pregnancy and Childbirth
Volume18
Number of pages11
ISSN1471-2393
DOIs
Publication statusPublished - 6. Dec 2018

    Fingerprint

Keywords

  • Caseload midwifery
  • Cohort study
  • Labour outcome
  • Multivariate Analysis
  • Labor, Induced/statistics & numerical data
  • Obstetric Labor Complications/epidemiology
  • Humans
  • Cesarean Section/statistics & numerical data
  • Young Adult
  • Labor, Obstetric
  • Apgar Score
  • Delivery, Obstetric
  • Lacerations/epidemiology
  • Adult
  • Female
  • Registries
  • Midwifery/organization & administration
  • Odds Ratio
  • Infant, Newborn
  • Delivery of Health Care/organization & administration
  • Continuity of Patient Care
  • Emergencies
  • Linear Models
  • Logistic Models
  • Pregnancy
  • Denmark
  • Cohort Studies

Cite this