Clinical interventions and outcomes of One-to-One midwifery practice

Background Changing Childbirth became policy for the maternity services in England in 1994 and remains policy. One-to-One midwifery was implemented to achieve the targets set. it was the first time such a service had been imp lemented in the Health Service. An evaluation was undertaken to compare its performance with conventional maternity care. Methods This was a prospective comparative study of women receiving One-to- One care and women receiving the system of care that One-to-One replaced (c onventional care) to compare achievement of continuity of carer and clinica l outcomes. The evaluation took place in The Hammersmith Hospitals NHS Trus t, the Queen Charlotte's and Hammersmith Hospitals. This was part of a larg er study, which included the evaluation of women's responses, cost implicat ions, and clinical standards and staff reactions. The participants were all those receiving One-to-One midwifery practice (728 women), which was confi ned to two postal districts, and all women receiving care in the system tha t One-to-One replaced, in two adjacent postal districts (675 women), and ex pecting to give birth between 15 August 1994 and 14 August 1995. Main outco me measures were achievement of continuity of care, rates of interventions in labour, length of labour, maternal and infant morbidity, and breastfeedi ng rates. Results A high degree of continuity was achieved through the whole process of maternity care. One-to-One women saw fewer staff at each stage of their care, knew more of the staff who they did see, and had a high level of cons tant support in labour. One-to-One practice was associated with a significa nt reduction in the use of epidural anaesthesia (odds ratio (OR) 95 per cen t confidence interval (CI) = 0.59 (0.44, 0.80)), with fewer rates of episio tomy and perineal lacerations (OR 95 per cent Cl = 0.70 (0.50, 0.98)), and with shorter second stage labour (median 40 min vs 48 min). There were no s tatistically significant differences in operative and assisted delivery or breastfeeding rates. Conclusions This study confirms that One-to-One midwifery practice can prov ide a high deg ree of continuity of carer, a nd is associated with a reduct ion in the rate of a number of interventions, without com promising safety of ca re. It should be extended locally and replicated in other services un der continuing evaluation.