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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: Lancet, 1996; 348(9022):213-218
Publisher: Elsevier
Issue Date: 1996
ISSN: 0140-6736
Statement of
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: BACKGROUND: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. METHODS: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. FINDINGS: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]). INTERPRETATION: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; Outcome Assessment (Health Care); Female; Surveys and Questionnaires
Rights: © 1996 Elsevier Ltd. All rights reserved.
RMID: 0030006387
DOI: 10.1016/S0140-6736(95)11207-3
Appears in Collections:Public Health publications

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