A SYSTEMATIC REVIEW COMPARING CONTINUITY OF MIDWIFERY CARE WITH STANDARD MATERNITY SERVICES

Objective To review randomised controlled trials of alternative matern ity services characterised by continuity of midwifery care. Methods A systematic review of randomised controlled trials, analysed on an inte ntion to treat basis, in which the study intervention was characterise d by a midwife or small group of midwives providing care from early pr egnancy to the postnatal period (defined as that provided on the postn atal ward); and the controls by standard maternity care as practised i n the place where the trial was conducted. The seven trials identified included 9148 women. Main outcome measures were interventions during labour, maternal outcomes and infant outcomes.Results The alternative models with continuity of midwifery care were associated with less use of obstetric interventions during labour (eg, induction, augmentation of labour, electronic fetal monitoring, obstetric analgesia, instrume ntal vaginal delivery and episiotomy). However, the caesarean section rate did not differ statistically between the trial groups (OR 0.91; 9 5% CI 0.78 to 1.05). The lower episiotomy rate in the alternative mode ls of care (OR 0.69; 95% CI 0.61 to 0.77) was associated with a signif icantly higher rate of perineal tears in the pooled alternative groups (OR 1.15; 95% CI 1.05 to 1.26). The percentage of intact perineums wa s very similar for the two groups (OR 1.11; 95% CI 1.00 to 1.24). Ther e was no maternal death, and rates of maternal complications based on unpooled estimates did not show any statistically significant differen ces. The proportion of babies with an Apgar score < 7 at five minutes after the birth was approximately the same in the pooled alternative g roups as in the control groups (OR 1.13 95% CI 0.69 to 1.84). Admissio n to intensive care or special care baby unit was similar (OR 0.86; 95 % CI 0.71 to 1.04). The difference in perinatal deaths was bordering o n statistical significance (OR 1.60; 95% CI 0.99 to 2.59). Conclusion Continuity of midwifery care is associated with lower intervention rat es than standard maternity care. No statistically significant differen ces were observed in maternal and infant outcomes. However, more resea rch is necessary to make definite conclusions about safety, for the in fant as well as for the mother. This review illustrates the variation in the different models of alternative and standard maternity care, an d thus the problems associated with pooling data from different trials .