A comparison of partnership caseload midwifery care with conventional team midwifery care: labour and birth outcomes.
OBJECTIVE
to compare the effects of partnership caseload midwifery care, with conventional team midwifery care. Comparisons of labour interventions and birth outcomes were made between the two models of care.


METHODS
a prospective, non-randomised clinical trial.


METHODS
Women's Hospital at Leicester Royal Infirmary, Leicester, UK in 1998.


METHODS
303 women from the experimental group and 308 from the control group (611 in total) matched for age, ethnicity, marital status, parity, gravida and height who gave birth between April 1997 and August 1998.


METHODS
the control group received conventional team midwifery care during pregnancy, labour and birth, and the experimental group received care from midwives working in partnerships that provided continuity of care during pregnancy, labour and birth.


RESULTS
21% of women in the experimental group had an epidural compared with 32% of the controls (OR 0.56 95%, CI 0.39-0.81, P=0.002). The normal vaginal birth rate (74% v 66%, OR 1.45, 95% CI 1.02-2.05, P=0.038), upright birth posture rate (60% v 14%, OR 9.64, 95% CI 5.96-15.61, P= or <0.001), intact perineum rate (40% v 30%, OR 1.57, 95% CI 1.05-2.35, P=0.027), and physiological third stage rate (37% v 1.5%, OR 38.69, 95% CI 11.98-124.89, P= or <0.001) were significantly higher in the experimental group. The induction of labour rate (16% v 23%, OR 0.66, 95% CI 0.44-0.98, P=0.042) was significantly lower in the experimental group. Women in the experimental group had more home births (17% v 1.3%, OR 15.38. 95% CI 5.48-43.14, P= or <0.001); used the midwife-led birthing suite more often (28% v 12%, OR 2.77, 95% CI 1.82-4.22, P= or <0.001); were more likely to take an early discharge (two to six hours) from hospital following birth (25% v 3%, OR 11.32. 95% CI 5.55-23.06, P= or <0.001); and were attended in birth more often by either their named midwife (67% v 5%, OR 39.65, 95% CI 22.38-70.25, P= or <0.001) or her partner (known midwife) (84% v 14%, OR 32.74, CI 20.96-51.14, P= or <0.001).


CONCLUSIONS
partnership caseload midwifery care resulted in less interventionist labour and more normal birth than conventional team midwifery care. Women in the experimental group had more home births, birth in a midwife-led suite and opted for early discharge home postnatally more often than the controls. They also experienced much higher levels of continuity, particularly of a known midwife during labour and birth. The study findings should encourage other maternity units in the UK to pilot and evaluate the model to see if these benefits are transferable.
Benjamin
Y
Y
Neonatal Unit, Leicester General Hospital, Gwendolyn Rd, Leicester.
Walsh
D
D
Taub
N
N
D000328:Adult; D000767:Anesthesia, Epidural / Q000451:nursing / Q000706:statistics & numerical data; D000773:Anesthesia, Obstetrical / Q000451:nursing / Q000706:statistics & numerical data; D003266:Continuity of Patient Care / Q000592:standards / Q000706:statistics & numerical data; D036861:Delivery, Obstetric / Q000379:methods / Q000451:nursing* / Q000592:standards* / Q000706:statistics & numerical data; D005260:Female; D006700:Home Childbirth / Q000706:statistics & numerical data; D006801:Humans; D007751:Labor, Induced / Q000706:statistics & numerical data; D008880:Midwifery / Q000458:organization & administration*; D009721:Nurse Midwives / Q000458:organization & administration*; D015403:Nursing Evaluation Research; D009746:Nursing, Team / Q000458:organization & administration*; D010043:Outcome and Process Assessment, Health Care; D010351:Patient Discharge / Q000706:statistics & numerical data; D011247:Pregnancy; D011256:Pregnancy Outcome / Q000453:epidemiology; D011321:Primary Nursing / Q000458:organization & administration*; D011446:Prospective Studies; D016526:Workload