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Randomized Controlled Trial
. 2016 Feb 3:16:28.
doi: 10.1186/s12884-016-0798-y.

Continuity of care by a primary midwife (caseload midwifery) increases women's satisfaction with antenatal, intrapartum and postpartum care: results from the COSMOS randomised controlled trial

Della A Forster  1   2 , Helen L McLachlan  3   4 , Mary-Ann Davey  5 , Mary Anne Biro  6 , Tanya Farrell  7 , Lisa Gold  8 , Maggie Flood  9 , Touran Shafiei  10 , Ulla Waldenström  11
Affiliations
Randomized Controlled Trial

Continuity of care by a primary midwife (caseload midwifery) increases women's satisfaction with antenatal, intrapartum and postpartum care: results from the COSMOS randomised controlled trial

Della A Forster et al. BMC Pregnancy Childbirth. .

Abstract

Background: Continuity of care by a primary midwife during the antenatal, intrapartum and postpartum periods has been recommended in Australia and many hospitals have introduced a caseload midwifery model of care. The aim of this paper is to evaluate the effect of caseload midwifery on women's satisfaction with care across the maternity continuum.

Methods: Pregnant women at low risk of complications, booking for care at a tertiary hospital in Melbourne, Australia, were recruited to a randomised controlled trial between September 2007 and June 2010. Women were randomised to caseload midwifery or standard care. The caseload model included antenatal, intrapartum and postpartum care from a primary midwife with back-up provided by another known midwife when necessary. Women allocated to standard care received midwife-led care with varying levels of continuity, junior obstetric care, or community-based general practitioner care. Data for this paper were collected by background questionnaire prior to randomisation and a follow-up questionnaire sent at two months postpartum. The primary analysis was by intention to treat. A secondary analysis explored the effect of intrapartum continuity of carer on overall satisfaction rating.

Results: Two thousand, three hundred fourteen women were randomised: 1,156 to caseload care and 1,158 to standard care. The response rate to the two month survey was 88% in the caseload group and 74% in the standard care group. Compared with standard care, caseload care was associated with higher overall ratings of satisfaction with antenatal care (OR 3.35; 95% CI 2.79, 4.03), intrapartum care (OR 2.14; 95% CI 1.78, 2.57), hospital postpartum care (OR 1.56, 95% CI 1.32, 1.85) and home-based postpartum care (OR 3.19; 95% CI 2.64, 3.85).

Conclusion: For women at low risk of medical complications, caseload midwifery increases women's satisfaction with antenatal, intrapartum and postpartum care.

Trial registration: Australian New Zealand Clinical Trials Registry ACTRN012607000073404 (registration complete 23rd January 2007).

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Figures

Fig. 1
Fig. 1
Trial profile
Fig. 2
Fig. 2
Comparison of women’s assessment of different aspects of antenatal, intrapartum and postpartum care, and overall assessment of these episodes of care and domiciliary postnatal care. Odds Ratios (ORs) based on comparisons of score on 7-point scales ranging from ‘1’ (Disagree strongly) to ‘7’ (Agree strongly). All p values for ORs shown are p < 0.001
See this image and copyright information in PMC

References

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    1. Rowley MJ, Hensley MJ, Brinsmead MW, Wlodarczyk JH. Continuity of Care by a midwife team versus routine care during pregnancy and birth: a randomised trial. Med J Aust. 1995;163:289–93. - PubMed

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