Journal Article

Randomised, controlled trial of efficacy of midwife-managed care

Holmes, Ann, Twaddle, Sara, Gilmour, W Harper, Lunan, C Burnett, Shields, Noreen, Johnstone, Irene, Mcllwaine, Gillian, Cheyne, Helen, Geer, Ian, Tumbull, Deborah, McGinley, Mary, Reid, Margaret

1996

Overview

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. We carried out a randomised controlled trial of 1 299 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. 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]). We conclude that midwife-managed care for healthy women, integrated within existing services, is clinically effective and enhances women's satisfaction with maternity care.

• Publisher: Elsevier Ltd,Elsevier Limited
• Subject: Adult / Delivery, Obstetric - methods / Female / Health care / Humans / Infant, Newborn / Medical research / Midwifery / Midwifery - methods / Obstetrics - methods / Outcome Assessment (Health Care) / Patient Care Team / Patient Satisfaction / Postnatal Care / Pregnancy / Prenatal Care - methods / Surveys and Questionnaires