A RANDOMIZED, CONTROLLED TRIAL OF NURSE-MIDWIFERY CARE

Background: In 1990 a pilot nurse-midwifery program was implemented in a tertiary care hospital in a major western. Canadian city. A randomi zed controlled trial was conducted to determine if, when maternal and newborn patient outcomes were compared, the midwifery program was as e ffective as traditional, low-risk health care available in the city. M ethods: All low-risk women who requested and qualified for nurse-midwi fery cave were randomly assigned to an experimental or control group. Results: One hundred one women received care from nurse-midwives and 9 3 received standard care from either an obstetrician or family physici an. The rate of cesarean delivery in the nurse-midwife group was 4 per cent compared with 15.1 percent in the physician group. The episiotomy rate, excluding cesarean deliveries,for the nurse-midwife group was 1 5.5 percent compared with 32.9 percent in the physician group. The rat es of epidural anesthesia for pain relief in labor were 12.9 percent a nd 23.7 percent, respectively. Statistically significant differences w ere found for ultrasound examinations, amniotomy intravenous drug admi nistration. during labor dietary, supplements, length of hospital stay and admission of infants to the neonatal intensive care unit. Conclus ions: The results clearly support the effectiveness of the pilot nurse -midwifery program and suggest that more extensive participation of mi dwives in the Canadian health care system is an appropriate use of hea lth care dollars.