A randomised study of midwifery caseload care and traditional 'shared-care'

Abstract

Objectives: To evaluate caseload midwifery care in comparison to traditional 'shared care'.

Design: Comparative study with area randomisation.

Setting: District general hospital in England.

Main outcome measures: 'Known carer at delivery,' 'normal vaginal delivery' and 'obstetric intervention'.

Subjects: All pregnant women delivering in the six areas chosen for the study.

Main findings: A highly significant difference was found between caseload and traditional care groups in terms of level of 'known carer at delivery' (696/770 94.7%; cf. 52/735 (6.7%), p < 0.001). However, no differences in 'normal vaginal delivery' rates were found (542/770 (70%) cf. 509/735 (69%). There were fewer 'obstetric interventions' in the caseload group, particularly epidural analgesia (80/770 (10%) cf. 110/735 (15%) p = 0.01) and oxytocin augmentation (351/77 (46%) cf. 387/735 (53%), p = 0.01). There were no significant differences found in terms of neonatal outcome.

Conclusions: Caseload midwifery results in high levels of 'known carer at delivery' which appears to be associated with a reduction in augmentation and epidural rates but which were not associated with an increase in normal vaginal delivery rate.