A comparison of the outcomes of partnership caseload midwifery and standard hospital care in low risk mothers

Background: Maternal and infant clinical outcomes were compared for low risk mothers receiving a partnership caseload model of midwifery care, known as Primary Health Midwifery Care (PHMC), and standard hospital care (SHC). Methods: Using secondary analysis of data from the Obstet Data System routine collection (PHMC n=976, SHC n=976) from a large metropolitan hospital, maternal and infant clinical outcomes were examined. Results: Odds ratios (OR) demonstrated reduced rates of interventions for multiparous women (OR 0.62 [CI 0.49-0.80]), with multiparous women receiving PHMC being more likely to have a normal delivery (OR 1.75 [CI 1.22-2.5]). A higher proportion of both primiparous and multiparous women receiving PHMC received pethidine during labour (OR 1.78 [1.33-2.39], OR 1.55 [1.19-2.01] respectively). Primiparous women receiving PHMC underwent fewer episiotomies with an associated increase in the proportion of women experiencing perineal tears (OR 1.93, CI 2.35-2.78), although perineum trauma rates were similar for both care models. Similar and very small numbers of infants in both parity groups and care models had an Apgar of less than seven at five minutes or were admitted to the neonatal intensive care unit or special care unit. Conclusion: This study, within the limitations of its design, supports the safety of the partnership caseload midwifery care model, in addition to reduced rates of interventions experienced by multiparous women and fewer episiotomies in primiparous low risk English-speaking women receiving caseload care. (author abstract)