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Comparative Study
. 2018 Aug 13;18(1):329.
doi: 10.1186/s12884-018-1969-9.

Effects of midwife-led maternity services on postpartum wellbeing and clinical outcomes in primiparous women under China's one-child policy

Jing Hua  1 , Liping Zhu  2 , Li Du  3 , Yu Li  4 , Zhuochun Wu  5 , Da Wo  6 , Wenchong Du  7
Affiliations
Comparative Study

Effects of midwife-led maternity services on postpartum wellbeing and clinical outcomes in primiparous women under China's one-child policy

Jing Hua et al. BMC Pregnancy Childbirth. .

Abstract

Background: The Midwife-led maternity services have been implemented in China in response to the high rates of primiparous women and Caesarean Sections (CS) which may be related to China's one-child policy. However, few studies in China have been reported on the effectiveness of Midwife-led Care at Delivery (MCD) and the Continuity of Midwife-led Care (CMC) on postpartum wellbeing and other clinical outcomes. Therefore, evidence-based clinical validation is needed to develop an optimal maternity service for childbearing women in China.

Methods: A concurrent cohort study design was conducted with 1730 pregnant women recruited from 9 hospitals in Shanghai. Among the 1730 participants at baseline, 1568 participants completed the follow-up questionnaire, with a follow-up rate of 90.6%.

Results: Compared with the routine Obstetrician-led Maternity Care (OMC), Midwife-led Care at Delivery (MCD) was associated with CS rate (OR were 0.16; 95%CI: 0.11 to 0.25) and a higher total score of postpartum wellbeing (βwere 2.70; 95%CI: 0.70 to 4.70) when adjusting for the baseline differences and other confounders during delivery or postpartum period. Moreover, continuity of Midwife-led Care (CMC) was associated with CS rate (OR were 0.30; 95%CI: 0.23 to 0.41), as well as increased rate of breastfeeding within the first 24 h (OR were 2.49; 95% CI: 1.47 to 4.23), higher postpartum satisfaction (β = 4.52; 95% CI: 1.60 to 12.68), lower anxiety (βwere 0.66; 95% CI: 0.16 to 1.17), increased self-control (βwere 0.39; 95% CI: 0.02 to 0.76) and a higher total score of postpartum wellbeing (βwere 3.14; 95% CI: 1.54 to 4.75).

Conclusion: CMC is the optimal service for low-risk primiparous women under China's one-child policy, and is worthwhile for a general implementation across China.

Keywords: China’s one-child policy; Midwife-led maternity services; Postpartum wellbeing.

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Conflict of interest statement

Ethical clearance was obtained from the ethics committees of the Shanghai First Maternity and Infant Hospital (KS1658). The study was carried out in accordance with the approved guidelines. The purposes of the study were explained to all participants verbally. Participants were assured of the confidentiality and anonymity. All participants signed an informed consent form prior to enrolment in the study. The participants were advised that they could withdraw from the study at any time they wished.

Not applicable.

The authors declare that they have no competing interests. The funding from National Natural Science Foundation of China under Grant(81,673,179, 81,402,687), the Shenkang Hospital Development Center under Grant(SHDC12016239,16CR1014A) play the roles in the study design and data collection. The study is also supported by the Fourth Round of Shanghai Three-year Action Plan on Public Health Discipline and Talent Program: Women and Children’s Health under Grant (15GWZK0401), Shanghai Municipal Commission of Health and Family Planning under Grant (201,640,060,2017ZZ02015) for analysis and interpretation of data and in writing and revising the manuscript.

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Number of women who completed the baseline and follow-up investigations
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