A comparison of partnership caseload midwifery care with conventional teammidwifery care: labour and birth outcomes

Objectives: to compare the effects of partnership caseload midwifery care, with conventional team midwifery care. Comparisons of labour interventions and birth outcomes were made between the two models of care. Design: a prospective, non-randomised clinical trial. Setting: Women's Hospital at Leicester Royal Infirmary, Leicester, UK in 19 98. Participants: 303 women from the experimental group and 308 from the contro l group (611 in total) matched for age, ethnicity, marital status, parity, gravida and height who gave birth between April 1997 and August 1998. Intervention: the control group received conventional team midwifery care d uring pregnancy, labour and birth, and the experimental group received care from midwives working in partnerships that provided continuity of care dur ing pregnancy, labour and birth. Key findings: 21% of women in the experimental group had an epidural compar ed with 32% of the controls (OR 0.56 95%, Cl 0.39-0.81, P=0.002). The norma l vaginal birth rate (74% v 66%, OR IAS, 95% Cl1.02-2.05, P=0.038), upright birth posture rate (60% v 14%, OR 9.64,95% Cl 5.96-15.61, P= <0.001), inta ct perineum rate (40% v 30%, OR 1.57,95% Cl 1.05-2.35, P=0.027), and physio logical third stage rate (37% v 1.5%, OR 38.69,95% Cl 11.98-124.89, P= < 0. 001) were significantly higher in the experimental group. The induction of labour rate (16% v 23%, OR 0.66,95% Cl 0.44-0.98, P=0.042) was significantl y lower in the experimental group. Women in the experimental group had more home births (17% v 1.3%, OR 15.38.95% Cl 5.48-43.14, P= < 0.001); used the midwife-led birthing suite more often (28% v 12%, OR 2.77,95% Cl 1.82-4.22 , P= < 0.001); were more likely to take an early discharge (two to six hour s) from hospital following birth (25% v 3%, OR 11.32.95% Cl 5.55-23.06, P < 0.001); and were attended in birth more often by either their named midwif e (67% v 5%, OR 39.65, 9S% Cl 22.38-70.25, P= < 0.001) or her partner (know n midwife) (84% v 14%, OR 32.74, Cl 20.96-51.14 P= < 0.001)., Implications for practice: partnership caseload midwifery care resulted in less interventionist labour and more normal birth than conventional team mi dwifery care. Women in the experimental group had more home births, birth i n a midwife-led suite and opted for early discharge home postnatally more o ften than the controls. They also experienced much higher levels of continu ity, particularly of a known midwife during labour and birth. The study fin dings should encourage other maternity units in the UK to pilot and evaluat e the model to see if these benefits are transferable. <(c)> 2001 Harcourt Publishers Ltd.