The effect of primary midwife‐led care on women's experience of childbirth: results from the COSMOS randomised controlled trial

Objective To determine the effect of primary midwife‐led care (‘caseload midwifery’) on women's experiences of childbirth. Design Randomised controlled trial. Setting Tertiary care women's hospital in Melbourne, Australia. Population A total of 2314 low‐risk pregnant women. Methods Women randomised to caseload care received antenatal, intrapartum and postpartum care from a primary midwife, with some care provided by a ‘back‐up’ midwife. Women in standard care received midwifery‐led care with varying levels of continuity, junior obstetric care or community‐based medical care. Main outcome measures The primary outcome of the study was caesarean section. This paper presents a secondary outcome, women's experience of childbirth. Women's views and experiences were sought using seven‐point rating scales via postal questionnaires 2 months after the birth. Results A total of 2314 women were randomised between September 2007 and June 2010; 1156 to caseload and 1158 to standard care. Response rates to the follow‐up questionnaire were 88 and 74%, respectively. Women in the caseload group were more positive about their overall birth experience than women in the standard care group (adjusted odds ratio 1.50, 95% CI 1.22–1.84). They also felt more in control during labour, were more proud of themselves, less anxious, and more likely to have a positive experience of pain. Conclusions Compared with standard maternity care, caseload midwifery may improve women's experiences of childbirth. Tweetable Primary midwife‐led care (‘caseload midwifery’) improves women's experiences of childbirth. Tweetable Primary midwife‐led care (‘caseload midwifery’) improves women's experiences of childbirth.