Randomised, controlled trial of efficacy of midwife-managed care.
BACKGROUND
Midwife-managed programmes of care are being widely implemented although there has been little investigation of their efficacy. We have compared midwife-managed care with shared care (ie, care divided among midwives, hospital doctors, and general practitioners) in terms of clinical efficacy and women's satisfaction.


METHODS
We carried out a randomised controlled trial of 1299 pregnant women who had no adverse characteristics at booking (consent rate 81.9%). 648 women were assigned midwife-managed care and 651 shared care. The research hypothesis was that compared with shared care, midwife-managed care would produce fewer interventions, similar (or more favourable) outcomes, similar complications, and greater satisfaction with care. Data were collected by retrospective review of case records and self-report questionnaires. Analysis was by intention to treat.


RESULTS
Interventions were similar in the two groups or lower with midwife-managed care. For example, women in the midwife-managed group were less likely than women in shared care to have induction of labour (146 [23.9%] vs 199 [33.3%]; 95% CI for difference 4.4-14.5). Women in the midwife-managed group were more likely to have an intact perineum and less likely to have had an episiotomy (p = 0.02), with no significant difference in perineal tears. Complication rates were similar. Overall, 32.8% of women were permanently transferred from midwife-managed care (28.7% for clinical reasons, 3.7% for non-clinical reasons). Women in both groups reported satisfaction with their care but the midwife-managed group were significantly more satisfied with their antenatal (difference in mean scores 0.48 [95% CI 0.41-0.55]), intrapartum (0.28 [0.18-0.37]), hospital-based postnatal care (0.57 [0.45-0.70]), and home-based postnatal care (0.33 [0.25-0.42]).


CONCLUSIONS
We conclude that midwife-managed care for healthy women, integrated within existing services, is clinically effective and enhances women's satisfaction with maternity care.
Turnbull
D
D
Midwifery Development Unit, Glasgow Royal Maternity Hospital, UK.
Holmes
A
A
Shields
N
N
Cheyne
H
H
Twaddle
S
S
Gilmour
W H
WH
McGinley
M
M
Reid
M
M
Johnstone
I
I
Geer
I
I
McIlwaine
G
G
Lunan
C B
CB
D000328:Adult; D036861:Delivery, Obstetric / Q000379:methods; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D008880:Midwifery / Q000379:methods; D009774:Obstetrics / Q000379:methods; D017063:Outcome Assessment, Health Care; D010348:Patient Care Team; D017060:Patient Satisfaction; D011181:Postnatal Care; D011247:Pregnancy; D011295:Prenatal Care / Q000379:methods*; D011795:Surveys and Questionnaires