RANDOMIZED, CONTROLLED TRIAL OF EFFICACY OF MIDWIFE-MANAGED CARE

Background Midwife-managed programmes of care are being widely impleme nted although there has been little investigation of their efficacy. W e have compared midwife-managed care with shared care (ie, care divide d among midwives, hospital doctors, and general practitioners) in term s of clinical efficacy and women's satisfaction. Methods We carried ou t a randomised controlled trial of 1299 pregnant women who had no adve rse characteristics at booking (consent rate 81.9%). 648 women were as signed midwife-managed care and 651 shared care. The research hypothes is was that compared with shared care, midwife-managed care would prod uce fewer interventions, similar (or more favourable) outcomes, simila r complications, and greater satisfaction with care. Data were collect ed by retrospective review of case records and self-report questionnai res. Analysis was by intention to treat. Findings Interventions were s imilar in the two groups or lower with midwife-managed care. For examp le, 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%]; 9 5% Cl for difference 4.4-14.5). Women in the midwife-managed group wer e more likely to have an intact perineum and less likely to have had a n episiotomy (p=0.02), with no significant difference in perineal tear s. Complication rates were similar. Overall, 32.8% of women were perma nently transferred from midwife-managed care (28.7% for clinical reaso ns, 3.7% for non-clinical reasons). Women in both groups reported sati sfaction with their care but the midwife-managed group were significan tly more satisfied with their antenatal (difference in mean scores 0.4 8 [95% Cl 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 fo r healthy women, integrated within existing services, is clinically ef fective and enhances women's satisfaction with maternity care.