Midwife managed delivery unit: a randomised controlled comparison with consultant led care.
OBJECTIVE
To examine whether intrapartum care and delivery of low risk women in a midwife managed delivery unit differs from that in a consultant led labour ward.


METHODS
Pragmatic randomised controlled trial. Subjects were randomised in a 2:1 ratio between the midwives unit and the labour ward.


METHODS
Aberdeen Maternity Hospital, Grampian.


METHODS
2844 low risk women, as defined by existing booking criteria for general practitioner units in Grampian. 1900 women were randomised to the midwives unit and 944 to the labour ward.


METHODS
Maternal and perinatal morbidity.


RESULTS
Of the women randomised to the midwives unit, 647 (34%) were transferred to the labour ward antepartum, 303 (16%) were transferred intrapartum, and 80 (4%) were lost to follow up. 870 women (46%) were delivered in the midwives unit. Primigravid women (255/596, 43%) were significantly more likely to be transferred intrapartum than multi-gravid women (48/577, 8%). Significant differences between the midwives unit and labour ward were found in monitoring, fetal distress, analgesia, mobility, and use of episiotomy. There were no significant differences in mode of delivery or fetal outcome.


CONCLUSIONS
Midwife managed intrapartum care for low risk women results in more mobility and less intervention with no increase in neonatal morbidity. However, the high rate of transfer shows that antenatal criteria are unable to determine who will remain at low risk throughout pregnancy and labour.
Hundley
V A
VA
Department of Obstetrics and Gynaecology, University of Aberdeen, Aberdeen Maternity Hospital.
Cruickshank
F M
FM
Lang
G D
GD
Glazener
C M
CM
Milne
J M
JM
Turner
M
M
Blyth
D
D
Mollison
J
J
Donaldson
C
C
D003253:Consultants; D003696:Delivery Rooms / Q000458:organization & administration; D036861:Delivery, Obstetric / Q000379:methods; D005260:Female; D006771:Hospitals, Maternity; D006801:Humans; D007743:Labor, Obstetric; D009721:Nurse Midwives; D007744:Obstetric Labor Complications; D010298:Parity; D010360:Patient Transfer / Q000706:statistics & numerical data; D011247:Pregnancy; D011256:Pregnancy Outcome; D012307:Risk Factors; D012606:Scotland; D000078329:Workforce