Getting the first birth right: A retrospective study of outcomes for low-risk primiparous women receiving standard care versus midwifery model of care in the same tertiary hospital |
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| Institution: | 1. University of Canberra, Bruce, ACT, Australia;2. Centenary Hospital for Women and Children, ACT, Australia;1. School of Nursing and Midwifery, Griffith University, Australia;2. Auckland University of Technology, New Zealand;3. University of Canberra, Australia;4. Deakin University, Australia;5. Trans-Tasman Midwifery Education Consortium, Australia and New Zealand;1. Mother and Child Health Research, School of Nursing and Midwifery, Faculty of Health Sciences, La Trobe University 215 Franklin St. Melbourne, Victoria 3000, Australia;2. Royal Women''s Hospital, Parkville, 3052 Victoria, Australia;3. School of Nursing and Midwifery, La Trobe University, Bundoora, Victoria 3086, Australia;1. School of Nursing, Midwifery and Paramedicine, Australian Catholic University, Mater Research Institute - University of Queensland and School of Nursing and Midwifery University of Queensland, Level 2, Aubigny Place, Mater Health Services, Raymond Terrace, South Brisbane, QLD 4101, Australia;2. Mater Research Institute - University of Queensland and School of Nursing and Midwifery University of Queensland, Level 1, Aubigny Place, Mater Health Services, South Brisbane, QLD 4101, Australia;3. Mater Research Institute - University of Queensland and School of Nursing and Midwifery University of Queensland, Level 2, Aubigny Place, Mater Health Services, South Brisbane, QLD 4101, Australia;1. Midwifery Research Unit, Mater Research, Aubigny Place, Mater Health Services, Raymond Terrace, South Brisbane, Queensland 4101, Australia;2. Midwifery Research Unit, Mater Research Institute – University of Queensland, Raymond Terrace, South Brisbane, Queensland 4101, Australia;3. School of Nursing, Midwifery and Social Work, University of Queensland, Level 3, Chamberlain Building (35), St Lucia, Queensland 4165, Australia;4. Mothers, Babies and Women''s Health, Mater Health, Raymond Terrace, South Brisbane, Queensland 4101, Australia;5. Poche Centre for Indigenous Health, Sydney Medical School, University of Sydney, Edward Ford Building (A27), NSW 2006, Australia;6. Midwifery and Women''s Health Research Unit, University of Sydney, Royal Hospital for Women, Randwick, NSW 2031, Australia;7. Department of Paediatrics and Child health Westmead Children''s Clinical School, The University of Sydney, Westmead, NSW 2145, Australia;8. Westmead Neonatal Intensive Care Unit, Westmead Hospital, Western Sydney Local Health District, NSW 2145, Australia;1. School of Nursing & Midwifery, Griffith University, Brisbane, Australia;2. Menzies Health Institute, Griffith University, Brisbane, Australia;1. School of Nursing and Midwifery and Paramedicine, Curtin University, Bentley, Perth, Western Australia 6102, Australia;2. Department of Nursing and Midwifery Education and Research, King Edward Memorial Hospital, Subiaco, Western Australia 6009, Australia;3. King Edward Memorial Hospital, Subiaco, Western Australia, Australia |
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| Abstract: | BackgroundThere is national and international concern for increasing obstetric intervention in childbirth and rising caesarean section rates. Repeat caesarean section is a major contributing factor, making primiparous women an important target for strategies to reduce unnecessary intervention and surgeries in childbirth.AimThe aim was to compare outcomes for a cohort of low risk primiparous women who accessed a midwifery continuity model of care with those who received standard public care in the same tertiary hospital.MethodsA retrospective comparative cohort study design was implemented drawing on data from two databases held by a tertiary hospital for the period 1 January 2010 to 31 December 2011. Categorical data were analysed using the chi-squared statistic and Fisher's exact test. Continuous data were analysed using Student's t-test. Comparisons are presented using unadjusted and adjusted odds ratios, with 95% confidence intervals (CIs) and p-values with significance set at 0.05.ResultsData for 426 women experiencing continuity of midwifery care and 1220 experiencing standard public care were compared. The study found increased rates of normal vaginal birth (57.7% vs. 48.9% p = 0.002) and spontaneous vaginal birth (38% vs. 22.4% p = <0.001) and decreased rates of instrumental birth (23.5% vs. 28.5% p = 0.050) and caesarean sections (18.8% vs. 22.5% p = 0.115) in the midwifery continuity cohort. There were also fewer interventions in this group. No differences were found in neonatal outcomes.ConclusionStrategies for reducing caesarean section rates and interventions in childbirth should focus on primiparous women as a priority. This study demonstrates the effectiveness of continuity midwifery models, suggesting that this is an important strategy for improving outcomes in this population. |
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| Keywords: | Primiparous Birth Continuity Midwifery Birth centre |
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