title: The association between attendance of midwives and workload of midwives with the mode of birth: secondary analyses in the German healthcare system.
abstract: BACKGROUND
  The continuous rise in caesarean rates across most European countries raises multiple concerns. One factor in this development might be the type of care women receive during childbirth. 'Supportive care during labour' by midwives could be an important factor for reducing fear, tension and pain and decreasing caesarean rates. The presence and availability of midwives to support a woman in line with her needs are central aspects for 'supportive care during labour'.To date, there is no existing research on the influence of effective 'supportive care' by German midwives on the mode of birth. This study examines the association between the attendance and workload of midwives with the mode of birth outcomes in a population of low-risk women in a German multicentre sample.
  
  
  METHODS
  The data are based on a prospective controlled multicentre trial (n = 1,238) in which the intervention 'midwife-led care' was introduced. Four German hospitals participated between 2007 and 2009.Secondary analyses included a convenience sample of 999 low-risk women from the primary analyses who met the selection criterion 'low-risk status'. Participation was voluntary. The association between the mode of birth and the key variables 'attendance of midwives' and 'workload of midwives' was assessed using backward logistic regression models.
  
  
  RESULTS
  The overall rate of spontaneous delivery was 80.7% (n = 763). The 'attendance of midwives' and the 'workload of midwives' did not exhibit a significant association with the mode of birth. However, women who were not satisfied with the presence of midwives (OR: 2.45, 95% CI 1.54-3.95) or who did not receive supportive procedures by midwives (OR: 3.01, 95% CI 1.50-6.05) were significantly more likely to experience operative delivery or a caesarean. Further explanatory variables include the type of hospital, participation in childbirth preparation class, length of stay from admission to birth, oxytocin usage and parity.
  
  
  CONCLUSIONS
  Satisfaction with the presence of and supportive procedures by midwives are associated with the mode of birth. The presence and behaviour of midwives should suit the woman's expectations and fulfil her needs. For reasons of causality, we would recommend experimental or quasi-experimental research that would exceed the explorative character of this study.
authors.affiliation: Department of Nursing Science, University of Witten/Herdecke, Faculty of Health, Stockumer Str,12, D-58453 Witten, Germany. n.knape@hs-osnabrueck.de.
authors.forename: Nina
authors.initials: N
authors.lastname: Knape
authors.forename: Herbert
authors.initials: H
authors.lastname: Mayer
authors.forename: Wilfried
authors.initials: W
authors.lastname: Schnepp
authors.forename: Friederike
authors.initials: F
authors.lastname: zu Sayn-Wittgenstein
mesh_terms: D000293:Adolescent; D000328:Adult; D003521:Cyclopropanes; D036861:Delivery, Obstetric / Q000706:statistics & numerical data*; D005260:Female; D005858:Germany; D006761:Hospitals / Q000145:classification; D006801:Humans; D047029:Lactams, Macrocyclic; D007902:Length of Stay; D047028:Macrocyclic Compounds; D008880:Midwifery / Q000592:standards / Q000706:statistics & numerical data*; D010120:Oxytocics / Q000627:therapeutic use; D010121:Oxytocin / Q000627:therapeutic use; D017060:Patient Satisfaction; D018743:Perinatal Care / Q000592:standards / Q000706:statistics & numerical data*; D064186:Prenatal Education; D011392:Proline / Q000031:analogs & derivatives; D011446:Prospective Studies; D013449:Sulfonamides; D016526:Workload / Q000706:statistics & numerical data*; D055815:Young Adult
chemical_list: D003521:Cyclopropanes; D047029:Lactams, Macrocyclic; D047028:Macrocyclic Compounds; D010120:Oxytocics; D013449:Sulfonamides; D010121:Oxytocin; D011392:Proline; C585405:paritaprevir