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    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.

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    Authors
    Begley, Cecily
    Devane, Declan
    Clarke, Mike
    McCann, Colette
    Hughes, Patricia
    Reilly, Mary
    Maguire, Roisin
    Higgins, Shane
    Finan, Alan
    Gormally, Siobhan
    Doyle, Miriam
    Show allShow less
    Issue Date
    2011-10-29
    Keywords
    PREGNANCY
    CHILDBIRTH
    MIDWIFE
    Local subject classification
    CONSULTANT
    
    Metadata
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    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
    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
    ISSN
    1471-2393
    Sponsors
    This research was funded by HSE Dublin North East
    ae974a485f413a2113503eed53cd6c53
    10.1186/1471-2393-11-85
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    Nursing & Midwifery

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