Caseload Midwifery Care Versus Standard Maternity Care for Women of Any Risk

2014 ◽  
Vol 34 (4) ◽  
pp. 234-235
Author(s):  
S.K. Tracy ◽  
D.L. Hartz ◽  
M.B. Tracy ◽  
J. Allen ◽  
A. Forti ◽  
...  
Keyword(s):  
Maternity Care ◽  
Midwifery Care ◽  
Caseload Midwifery

Caseload midwifery care versus standard maternity care for women of any risk: M@NGO, a randomised controlled trial

The Lancet ◽  
2013 ◽  
Vol 382 (9906) ◽  
pp. 1723-1732 ◽  
Author(s):  
Sally K Tracy ◽  
Donna L Hartz ◽  
Mark B Tracy ◽  
Jyai Allen ◽  
Amanda Forti ◽  
...  
Keyword(s):  
Randomised Controlled Trial ◽  
Maternity Care ◽  
Controlled Trial ◽  
Midwifery Care ◽  
Caseload Midwifery ◽  
Randomised Controlled

scholarly journals Women’s characteristics and care outcomes of caseload midwifery care in the Netherlands: a retrospective cohort study

2020 ◽  
Vol 20 (1) ◽  
Author(s):  
Pien Offerhaus ◽  
Suze Jans ◽  
Chantal Hukkelhoven ◽  
Raymond de Vries ◽  
Marianne Nieuwenhuijze
Keyword(s):  
The Netherlands ◽  
Maternity Care ◽  
Perinatal Outcomes ◽  
Vaginal Birth ◽  
Current Effort ◽  
Midwifery Care ◽  
Caseload Midwifery ◽  
Multiparous Women ◽  
Mode Of Birth ◽  
Care Outcomes

Abstract Background The maternity care system in the Netherlands is well known for its support of community-based midwifery. However, regular midwifery practices typically do not offer caseload midwifery care – one-to-one continuity of care throughout pregnancy and birth. Because we know very little about the outcomes for women receiving caseload care in the Netherlands, we compared caseload care with regular midwife-led care, looking at maternal and perinatal outcomes, including antenatal and intrapartum referrals to secondary (i.e., obstetrician-led) care. Methods We selected 657 women in caseload care and 1954 matched controls (women in regular midwife-led care) from all women registered in the Dutch Perinatal Registry (Perined) who gave birth in 2015. To be eligible for selection the women had to be in midwife-led antenatal care beyond 28 gestational weeks. Each woman in caseload care was matched with three women in regular midwife-led care, using parity, maternal age, background (Dutch or non-Dutch) and region. These two cohorts were compared for referral rates, mode of birth, and other maternal and perinatal outcomes. Results In caseload midwifery care, 46.9% of women were referred to obstetrician-led care (24.2% antenatally and 22.8% in the intrapartum period). In the matched cohort, 65.7% were referred (37.4% antenatally and 28.3% in the intrapartum period). In caseload care, 84.0% experienced a spontaneous vaginal birth versus 77.0% in regular midwife-led care. These patterns were observed for both nulliparous and multiparous women. Women in caseload care had fewer inductions of labour (13.2% vs 21.0%), more homebirths (39.4% vs 16.1%) and less perineal damage (intact perineum: 41.3% vs 28.2%). The incidence of perinatal mortality and a low Apgar score was low in both groups. Conclusions We found that when compared to regular midwife-led care, caseload midwifery care in the Netherlands is associated with a lower referral rate to obstetrician-led care – both antenatally and in the intrapartum period – and a higher spontaneous vaginal birth rate, with similar perinatal safety. The challenge is to include this model as part of the current effort to improve the quality of Dutch maternity care, making caseload care available and affordable for more women.

Socioeconomic differences in access to care in Australia for women fearful of birth

2019 ◽  
Vol 43 (6) ◽  
pp. 639 ◽  
Author(s):  
Jocelyn Toohill ◽  
Emily Callander ◽  
Haylee Fox ◽  
Daniel Lindsay ◽  
Jenny Gamble ◽  
...  
Keyword(s):  
Health Policy ◽  
Low Income ◽  
Univariate Analysis ◽  
Perinatal Period ◽  
Positive Outcomes ◽  
Midwifery Care ◽  
Policy Makers ◽  
Caseload Midwifery ◽  
Significant Difference ◽  
Equity In Access

Objective Fear of childbirth is known to increase a woman’s likelihood of having a Caesarean section. Continuity of midwifery care is known to reduce this risk, but less than 8% of women have access to this relationship-based, primary care model. The aims of this study were to determine whether healthcare use and access to continuity models are equal across different indicators of socioeconomic status for women who are fearful of birth. Methods A secondary analysis was conducted of data obtained during a randomised controlled trial of a psychoeducation intervention by trained midwives to minimise childbirth fear (the Birth Emotions and Looking to Improve Expectant Fear (BELIEF) study). In all, 1410 women were screened, with 339 women reporting high levels of fear (Wijma-Delivery Expectancy/Experience Questionnaire ≥66). Demographic, obstetric information, birth preference and psychosocial measures were collected at recruitment and at 36 weeks gestation for the 339 fearful women, with the birth method and health service use returned by 183 women at 6 weeks after the birth. Results Univariate analysis revealed no significant difference in the number of general practitioner and midwife visits between women of high and low income and high and low education. However, women with higher levels of education had 2.51-fold greater odds of seeing the same midwife throughout their pregnancy than women with lower education (95% confidence interval 1.25–5.04), after adjusting for age, parity and hospital site. Conclusions Given the known positive outcomes of continuity of midwifery care for women fearful of birth, health policy makers need to provide equity in access to evidence-based models of midwifery care. What is known about this topic? Caseload midwifery care is considered the gold standard care due to the known positive outcomes it has for the mother and baby during the perinatal period. Pregnant women who receive caseload midwifery care are more likely to experience a normal vaginal birth. What does this paper add? There is unequal access to midwifery caseload care for women fearful of birth across socioeconomic boundaries. Midwifery caseload care is not used for all fearful mothers during the perinatal period. What are the implications for practitioners? Health policy makers seeking to provide equity in access to maternity care should be aware of these inequalities in use to target delivery of care at this specific cohort of mothers.

scholarly journals Maternal socio-economic disadvantage in Aotearoa New Zealand and the impact on midwifery care

2020 ◽  
Vol 56 ◽  
pp. 26-34
Author(s):  
Lesley Dixon ◽  
Eva Neely ◽  
Alison Eddy ◽  
Briony Raven ◽  
Carol Bartle
Keyword(s):  
New Zealand ◽  
Maternity Care ◽  
Survey Methodology ◽  
Social Issues ◽  
Economic Disadvantage ◽  
Midwifery Care ◽  
Pregnancy And Childbirth ◽  
Aotearoa New Zealand ◽  
Women's Lives ◽  
The Impact

Background: Maternal socio-economic disadvantage affects the short- and long-term health of women and their babies, with pregnancy being a particularly vulnerable time. Aim: The aim of this study was to identify the key factors that relate to poverty for women during pregnancy and childbirth (as identified by midwives), the effects on women during maternity care and the subsequent impact on the midwives providing that care. Method: Survey methodology was used to identify Aotearoa New Zealand midwives’ experiences of working with women living with socio-economic disadvantage. Findings: A total of 436 midwives (16.3%) who were members of the New Zealand College of Midwives responded to the survey, with 55% working in the community as Lead Maternity Care midwives, or caseloading midwives, and the remainder mostly working in maternity facilities. The survey results found that 70% of the cohort of midwives had worked with women living with whānau (family) /friends; 69% with women who had moved house during pregnancy due to the unaffordability of housing; 66% with women who lived in overcrowded homes; and 56.6% with women who lived in emergency housing, in garages (31.6%), in cars (16.5%) or on the streets (11%). The cohort of midwives identified that women’s non-attendance of appointments was due to lack of transport and lack of money for phones, resulting in a limited ability to communicate. In these circumstances these midwives reported going to women’s homes to provide midwifery care to optimise the chances of making contact. The midwives reported needing to spend more time than usual referring and liaising with other services and agencies, to ensure that the woman and her baby/ family had the necessities of life and health. This cohort of midwives identified that women’s insufficient income meant that midwives needed to find ways to support them to access prescriptions and transport for hospital appointments. The midwives also indicated there was a range of social issues, such as family violence, drugs, alcohol, and care and protection concerns, that directly affected their work. Conclusion: Recognising the impact of socio-economic disadvantage on maternal health and wellbeing is important to improving both maternal and child health. This cohort of midwives identified that they are frequently working with women living with disadvantage; they see the reality of women’s lives and the difficulties and issues they may face in relation to accessing physical and social support during childbirth.

Comparing Standard Maternity Care with Team Midwifery Care Provided by Student Midwives — A Pilot Study

2013 ◽  
Vol 33 (3) ◽  
pp. 14-19 ◽  
Author(s):  
Ingvild Aune ◽  
Unn Dahlberg ◽  
Bjørn Backe ◽  
Gørill Haugan
Keyword(s):  
Pilot Study ◽  
Maternity Care ◽  
Midwifery Care

Australian maternity reform through clinical redesign

2012 ◽  
Vol 36 (2) ◽  
pp. 169 ◽  
Author(s):  
Donna L. Hartz ◽  
Jan White ◽  
Kathleen A. Lainchbury ◽  
Helen Gunn ◽  
Helen Jarman ◽  
...  
Keyword(s):  
Randomised Trial ◽  
Maternity Hospital ◽  
Models Of Care ◽  
Group Practice ◽  
Model Of Care ◽  
Midwifery Care ◽  
Caseload Midwifery ◽  
Midwifery Group Practice ◽  
Practice Care

The current Australian national maternity reform agenda focuses on improving access to maternity care for women and their families while preserving safety and quality. The caseload midwifery model of care offers the level of access to continuity of care proposed in the reforms however the introduction of these models in Australia continues to meet with strong resistance. In many places access to caseload midwifery care is offered as a token, usually restricted to well women, within limited metropolitan and regional facilities and where available, places for women are very small as a proportion of the total service provided. This case study outlines a major clinical redesign of midwifery care at a metropolitan tertiary referral maternity hospital in Sydney. Caseload midwifery care was introduced under randomised trial conditions to provide midwifery care to 1500 women of all risk resulting in half of the publicly insured women receiving midwifery group practice care. The paper describes the organisational quality and safety tools that were utilised to facilitate the process while discussing the factors that facilitated the process and the barriers that were encountered within the workforce, operational and political context. What is known about the topic? Caseload midwifery models of care have been established in a variety of community based and hospital settings throughout Australia with a reported reduction in clinical intervention rates while maintainning safety of mothers and babies. What does this paper add? This case study illustrates the strategies used to achieve a large sustainable clinical service redesign project based on the introduction of the caseload midwifery model of care. What are the implications for practitioners? Establishing midwifery group practice care within the mainstream maternity services has far reaching implications for the retention and recruitment of midwives and the improvement of clinical outcomes in childbirth.

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