Team midwifery care in a tertiary level obstetric service: a randomized controlled trial.
BACKGROUND
In 1996 a new model of maternity care characterized by continuity of midwifery care from early pregnancy through to the postpartum period was implemented for women attending Monash Medical Centre, a tertiary level obstetric service, in Melbourne, Australia. The objective of this study was to compare the new model of care with standard maternity care.


METHODS
In a randomized controlled trial, 1000 women who booked at the antenatal clinic and met the eligibility criteria were randomly allocated to receive continuity of midwifery care (team care) from a group of seven midwives in collaboration with obstetric staff, or care from a variety of midwives and obstetric staff (standard care). The primary outcome measures were procedures in labor, maternal outcomes, neonatal outcomes, and length of hospital stay.


RESULTS
Women assigned to the team care group experienced less augmentation of labor, less electronic fetal monitoring, less use of narcotic and epidural analgesia, and fewer episiotomies but more unsutured tears. Team care women stayed in hospital 7 hours less than women in standard care. More babies of standard care mothers were admitted to the special care nurseries for more than 5 days because of preterm birth, and more babies of team care mothers were admitted to the nurseries for more than 5 days with intrauterine growth retardation. No differences occurred in perinatal mortality between the two groups.


CONCLUSIONS
Continuity of midwifery care was associated with a reduction in medical procedures in labor and a shorter length of stay without compromising maternal and perinatal safety. Continuity of midwifery care is realistically achievable in a tertiary obstetric referral service.
Women's Health Program of the Southern Health Care Network in Melbourne, Victoria, Australia.
M A
MA
Biró
U
U
Waldenström
J H
JH
Pannifex
D003266:Continuity of Patient Care; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007743:Labor, Obstetric; D007902:Length of Stay; D008427:Maternal Health Services / Q000458:organization & administration*; D008880:Midwifery / Q000458:organization & administration*; D009746:Nursing, Team; D017063:Outcome Assessment, Health Care; D010348:Patient Care Team; D011247:Pregnancy; D011248:Pregnancy Complications / Q000517:prevention & control; D011256:Pregnancy Outcome; D014739:Victoria