The effect of primary midwife-led care on women's experience of childbirth: results from the COSMOS randomised controlled trial.
OBJECTIVE
To determine the effect of primary midwife-led care ('caseload midwifery') on women's experiences of childbirth.


METHODS
Randomised controlled trial.


METHODS
Tertiary care women's hospital in Melbourne, Australia.


METHODS
A total of 2314 low-risk pregnant women.


METHODS
Women randomised to caseload care received antenatal, intrapartum and postpartum care from a primary midwife, with some care provided by a 'back-up' midwife. Women in standard care received midwifery-led care with varying levels of continuity, junior obstetric care or community-based medical care.


METHODS
The primary outcome of the study was caesarean section. This paper presents a secondary outcome, women's experience of childbirth. Women's views and experiences were sought using seven-point rating scales via postal questionnaires 2 months after the birth.


RESULTS
A total of 2314 women were randomised between September 2007 and June 2010; 1156 to caseload and 1158 to standard care. Response rates to the follow-up questionnaire were 88 and 74%, respectively. Women in the caseload group were more positive about their overall birth experience than women in the standard care group (adjusted odds ratio 1.50, 95% CI 1.22-1.84). They also felt more in control during labour, were more proud of themselves, less anxious, and more likely to have a positive experience of pain.


CONCLUSIONS
Compared with standard maternity care, caseload midwifery may improve women's experiences of childbirth.


CONCLUSIONS
Primary midwife-led care ('caseload midwifery') improves women's experiences of childbirth.
Judith Lumley Centre and School of Nursing and Midwifery, La Trobe University, Melbourne, Vic., Australia.
H L
HL
McLachlan
Judith Lumley Centre and School of Nursing and Midwifery, La Trobe University, Melbourne, Vic., Australia.|The Royal Women's Hospital, Parkville, Vic., Australia.
D A
DA
Forster
Judith Lumley Centre and School of Nursing and Midwifery, La Trobe University, Melbourne, Vic., Australia.|Consultative Council on Obstetric and Paediatric Mortality and Morbidity, Department of Health, Melbourne, Vic., Australia.
M-A
MA
Davey
The Royal Women's Hospital, Parkville, Vic., Australia.
T
T
Farrell
Judith Lumley Centre and School of Nursing and Midwifery, La Trobe University, Melbourne, Vic., Australia.
M
M
Flood
Judith Lumley Centre and School of Nursing and Midwifery, La Trobe University, Melbourne, Vic., Australia.
T
T
Shafiei
Department of Women's and Children's Health, Division of Reproductive and Perinatal Health, Karolinska Institutet, Stockholm, Sweden.
U
U
Waldenström
D000328:Adult; D036861:Delivery, Obstetric / Q000379:methods / Q000523:psychology*; D005260:Female; D006801:Humans; D008880:Midwifery; D036801:Parturition / Q000523:psychology*; D017060:Patient Satisfaction; D011247:Pregnancy; D011320:Primary Health Care
Birth experience; caseload midwifery; continuity of care; midwife-led care; primary midwife care; randomised controlled trial