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Labor outcomes in caseload midwifery compared with standard midwifery care: A cohort study: A cohort study

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Title: Labor outcomes in caseload midwifery compared with standard midwifery care: A cohort study: A cohort study
Authors: Sarah Hjorth, Anne‐Line Brülle, Helle Kristensen, Anette Frederiksen, Ellen Aagard Nohr
Source: Birth. 51:817-824
Publisher Information: Wiley, 2024.
Publication Year: 2024
Subject Terms: Adult, Denmark, Workload/statistics & numerical data, Obstetric/methods, Workload, Midwifery, Pregnancy Outcome/epidemiology, Cohort Studies, 03 medical and health sciences, 0302 clinical medicine, Pregnancy, Humans, Apgar score, midwifery, Labor, Obstetric, cesarean section, Cesarean Section, Pregnancy Outcome, Infant, Newborn, Infant, Obstetric, Cesarean Section/statistics & numerical data, Newborn, Delivery, Obstetric, Labor, 3. Good health, Midwifery/statistics & numerical data, obstetric labor complications, Apgar Score, Female, continuity of patient care, Delivery
Description: BackgroundResearch has shown caseload midwifery to increase the chance of vaginal birth, but this may not be the case in settings with high vaginal birth rates in standard care. This study investigated the association between caseload midwifery and birth mode, labor interventions, and maternal and neonatal outcomes at a large obstetric unit in Denmark.MethodsCohort study including medical records on live, singleton births fr om June 2018 until February 2022. Exposure was caseload midwifery care compared with standard midwifery care. The primary outcome was birth mode, and secondary outcomes were other outcomes of labor. Adjusted risk ratios (aRR) with 95% confidence intervals (CI) were estimated by log‐binomial regression.ResultsAmong 16,110 pregnancies, 3162 pregnancies (19.6%) received caseload midwifery care. Caseload midwifery was associated with fewer planned cesareans (aRR 0.63 [95% CI 0.54–0.74]) and emergency cesareans (aRR 0.86 [95% CI 0.75–0.95]). No differences in labor induction, use of epidural analgesia, oxytocin augmentation, or anal sphincter tears were observed. Caseload midwifery performed more amniotomies (aRR 1.14 [95% CI 1.02–1.27]) and tended to perform more episiotomies (aRR 1.19 [95% CI 0.96–1.48]). Postpartum hemorrhage (aRR 0.90 [95% CI 0.82–0.99]) and low Apgar score were less likely (aRR 0.54 [95% CI 0.37–0.77]), and early discharge more likely (aRR 1.22 [95% CI 1.17–1.28]) in caseload midwifery.ConclusionIn caseload midwifery care, a higher vaginal birth rate was observed with no increase in adverse outcomes, mainly due to a lower likelihood of planned cesarean. Also, fewer children were born with low Apgar scores.
Document Type: Article
Language: English
ISSN: 1523-536X
0730-7659
DOI: 10.1111/birt.12861
Access URL: https://pubmed.ncbi.nlm.nih.gov/39140615
https://portal.findresearcher.sdu.dk/da/publications/e40bdfb4-239b-416c-9735-59e0fe8bc7b4
https://doi.org/10.1111/birt.12861
Rights: CC BY NC
Accession Number: edsair.doi.dedup.....854a6f61d5bd187b612856c90219538c
Database: OpenAIRE
Description
Abstract:BackgroundResearch has shown caseload midwifery to increase the chance of vaginal birth, but this may not be the case in settings with high vaginal birth rates in standard care. This study investigated the association between caseload midwifery and birth mode, labor interventions, and maternal and neonatal outcomes at a large obstetric unit in Denmark.MethodsCohort study including medical records on live, singleton births fr om June 2018 until February 2022. Exposure was caseload midwifery care compared with standard midwifery care. The primary outcome was birth mode, and secondary outcomes were other outcomes of labor. Adjusted risk ratios (aRR) with 95% confidence intervals (CI) were estimated by log‐binomial regression.ResultsAmong 16,110 pregnancies, 3162 pregnancies (19.6%) received caseload midwifery care. Caseload midwifery was associated with fewer planned cesareans (aRR 0.63 [95% CI 0.54–0.74]) and emergency cesareans (aRR 0.86 [95% CI 0.75–0.95]). No differences in labor induction, use of epidural analgesia, oxytocin augmentation, or anal sphincter tears were observed. Caseload midwifery performed more amniotomies (aRR 1.14 [95% CI 1.02–1.27]) and tended to perform more episiotomies (aRR 1.19 [95% CI 0.96–1.48]). Postpartum hemorrhage (aRR 0.90 [95% CI 0.82–0.99]) and low Apgar score were less likely (aRR 0.54 [95% CI 0.37–0.77]), and early discharge more likely (aRR 1.22 [95% CI 1.17–1.28]) in caseload midwifery.ConclusionIn caseload midwifery care, a higher vaginal birth rate was observed with no increase in adverse outcomes, mainly due to a lower likelihood of planned cesarean. Also, fewer children were born with low Apgar scores.
ISSN:1523536X
07307659
DOI:10.1111/birt.12861