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https://hdl.handle.net/2440/4207
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Type: | Journal article |
Title: | Randomised, controlled trail of efficacy of midwife-managed care |
Author: | Turnbull, D. Holmes, A. Shields, N. Cheyne, H. Twaddle, S. Harper-Gilmour, W. McGinley, M. Reid, M. Johnstone, I. Geer, I. McIlwaine, G. Burnett Lunan, C. |
Citation: | The Lancet, 1996; 348(9022):213-218 |
Publisher: | Elsevier |
Issue Date: | 1996 |
ISSN: | 0140-6736 1474-547X |
Statement of Responsibility: | Deborah Tumbull, Ann Holmes, Noreen Shields, Helen Cheyne, Sara Twaddle, W Harper Gilmour, Mary McGinley, Margaret Reid, Irene Johnstone, Ian Geer, Gillian Mcllwaine, C Burnett Lunan |
Abstract: | <h4>Background</h4>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.<h4>Methods</h4>We carried out a randomised controlled trial of 1299 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.<h4>Findings</h4>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]).<h4>Interpretation</h4>We conclude that midwife-managed care for healthy women, integrated within existing services, is clinically effective and enhances women's satisfaction with maternity care. |
Keywords: | Humans Postnatal Care Prenatal Care Delivery, Obstetric Obstetrics Midwifery Pregnancy Adult Infant, Newborn Patient Satisfaction Patient Care Team Female Surveys and Questionnaires Outcome Assessment, Health Care |
Rights: | © 1996 Elsevier Ltd. All rights reserved. |
DOI: | 10.1016/S0140-6736(95)11207-3 |
Published version: | http://dx.doi.org/10.1016/s0140-6736(95)11207-3 |
Appears in Collections: | Aurora harvest Public Health publications |
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