Comparison of midwife-led and consultant-led care of healthy women at low risk of childbirth complications in the Republic of Ireland: a randomised trial.

Hdl Handle:
http://hdl.handle.net/10147/189013
Title:
Comparison of midwife-led and consultant-led care of healthy women at low risk of childbirth complications in the Republic of Ireland: a randomised trial.
Authors:
Begley, Cecily; Devane, Declan; Clarke, Mike; McCann, Colette; Hughes, Patricia; Reilly, Mary; Maguire, Roisin; Higgins, Shane; Finan, Alan; Gormally, Siobhan; Doyle, Miriam
Citation:
Comparison of midwife-led and consultant-led care of healthy women at low risk of childbirth complications in the Republic of Ireland: a randomised trial. 2011, 11 (1):85notBMC Pregnancy Childbirth
Journal:
BMC pregnancy and childbirth
Issue Date:
29-Oct-2011
URI:
http://hdl.handle.net/10147/189013
DOI:
10.1186/1471-2393-11-85
PubMed ID:
22035427
Abstract:
ABSTRACT: BACKGROUND: No midwifery-led units existed in Ireland before 2004. The aim of this study was to compare midwife-led (MLU) versus consultant-led (CLU) care for healthy, pregnant women without risk factors for labour and delivery. METHODS: An unblinded, pragmatic randomised trial was designed, funded by the Health Service Executive (Dublin North-East). Following ethical approval, all women booking prior to 24 weeks of pregnancy at two maternity hospitals with 1,300-3,200 births annually in Ireland were assessed for trial eligibility.1,653 consenting women were centrally randomised on a 2:1 ratio to MLU or CLU care, (1101:552). 'Intention-to-treat' analysis was used to compare 9 key neonatal and maternal outcomes. RESULTS: No statistically significant difference was found between MLU and CLU in the seven key outcomes: caesarean birth (163 [14.8%] vs 84 [15.2%]; relative risk (RR) 0.97 [95% CI 0.76 to 1.24]), induction (248 [22.5%] vs 138 [25.0%]; RR 0.90 [0.75 to 1.08]), episiotomy (126 [11.4%] vs 68 [12.3%]; RR 0.93 [0.70 to 1.23]), instrumental birth (139 [12.6%] vs 79 [14.3%]; RR 0.88 [0.68 to 1.14]), Apgar scores <8 (10 [0.9%] vs 9 [1.6%]; RR 0.56 [0.23 to 1.36]), postpartum haemorrhage (144 [13.1%] vs 75 [13.6%]; RR 0.96 [0.74 to 1.25]); breastfeeding initiation (616 [55.9%] vs 317 [57.4%]; RR 0.97 [0.89 to 1.06]). MLU women were significantly less likely to have continuous electronic fetal monitoring (397 [36.1%] vs 313 [56.7%]; RR 0.64 [0.57 to 0.71]), or augmentation of labour (436 [39.6%] vs 314 [56.9%]; RR 0.50 [0.40 to 0.61]). CONCLUSIONS: Midwife-led care, as practised in this study, is as safe as consultant-led care and is associated with less intervention during labour and delivery. Trial registration: Current Controlled Trials ISRCTN14973283.
Item Type:
Article In Press
Language:
en
Keywords:
PREGNANCY; CHILDBIRTH; MIDWIFE
Local subject classification:
CONSULTANT
ISSN:
1471-2393
Sponsors:
This research was funded by HSE Dublin North East

Full metadata record

DC FieldValue Language
dc.contributor.authorBegley, Cecilyen
dc.contributor.authorDevane, Declanen
dc.contributor.authorClarke, Mikeen
dc.contributor.authorMcCann, Coletteen
dc.contributor.authorHughes, Patriciaen
dc.contributor.authorReilly, Maryen
dc.contributor.authorMaguire, Roisinen
dc.contributor.authorHiggins, Shaneen
dc.contributor.authorFinan, Alanen
dc.contributor.authorGormally, Siobhanen
dc.contributor.authorDoyle, Miriamen
dc.date.accessioned2011-11-08T09:22:08Z-
dc.date.available2011-11-08T09:22:08Z-
dc.date.issued2011-10-29-
dc.identifier.citationComparison of midwife-led and consultant-led care of healthy women at low risk of childbirth complications in the Republic of Ireland: a randomised trial. 2011, 11 (1):85notBMC Pregnancy Childbirthen
dc.identifier.issn1471-2393-
dc.identifier.pmid22035427-
dc.identifier.doi10.1186/1471-2393-11-85-
dc.identifier.urihttp://hdl.handle.net/10147/189013-
dc.description.abstractABSTRACT: BACKGROUND: No midwifery-led units existed in Ireland before 2004. The aim of this study was to compare midwife-led (MLU) versus consultant-led (CLU) care for healthy, pregnant women without risk factors for labour and delivery. METHODS: An unblinded, pragmatic randomised trial was designed, funded by the Health Service Executive (Dublin North-East). Following ethical approval, all women booking prior to 24 weeks of pregnancy at two maternity hospitals with 1,300-3,200 births annually in Ireland were assessed for trial eligibility.1,653 consenting women were centrally randomised on a 2:1 ratio to MLU or CLU care, (1101:552). 'Intention-to-treat' analysis was used to compare 9 key neonatal and maternal outcomes. RESULTS: No statistically significant difference was found between MLU and CLU in the seven key outcomes: caesarean birth (163 [14.8%] vs 84 [15.2%]; relative risk (RR) 0.97 [95% CI 0.76 to 1.24]), induction (248 [22.5%] vs 138 [25.0%]; RR 0.90 [0.75 to 1.08]), episiotomy (126 [11.4%] vs 68 [12.3%]; RR 0.93 [0.70 to 1.23]), instrumental birth (139 [12.6%] vs 79 [14.3%]; RR 0.88 [0.68 to 1.14]), Apgar scores <8 (10 [0.9%] vs 9 [1.6%]; RR 0.56 [0.23 to 1.36]), postpartum haemorrhage (144 [13.1%] vs 75 [13.6%]; RR 0.96 [0.74 to 1.25]); breastfeeding initiation (616 [55.9%] vs 317 [57.4%]; RR 0.97 [0.89 to 1.06]). MLU women were significantly less likely to have continuous electronic fetal monitoring (397 [36.1%] vs 313 [56.7%]; RR 0.64 [0.57 to 0.71]), or augmentation of labour (436 [39.6%] vs 314 [56.9%]; RR 0.50 [0.40 to 0.61]). CONCLUSIONS: Midwife-led care, as practised in this study, is as safe as consultant-led care and is associated with less intervention during labour and delivery. Trial registration: Current Controlled Trials ISRCTN14973283.-
dc.description.sponsorshipThis research was funded by HSE Dublin North Easten
dc.languageENG-
dc.language.isoenen
dc.subjectPREGNANCYen
dc.subjectCHILDBIRTHen
dc.subjectMIDWIFEen
dc.subject.otherCONSULTANTen
dc.titleComparison of midwife-led and consultant-led care of healthy women at low risk of childbirth complications in the Republic of Ireland: a randomised trial.en
dc.typeArticle In Pressen
dc.identifier.journalBMC pregnancy and childbirthen

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