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

• Main Authors: Begley Cecily (Author), Devane Declan (Author), Clarke Mike (Author), McCann Colette (Author), Hughes Patricia (Author), Reilly Mary (Author), Maguire Roisin (Author), Higgins Shane (Author), Finan Alan (Author), Gormally Siobhan (Author), Doyle Miriam (Author)
• Format: Book
• Published: BMC, 2011-10-01T00:00:00Z.
• Subjects: article
• Online Access: Connect to this object online.

Summary

<p>Abstract</p> <p>Background</p> <p>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.</p> <p>Methods</p> <p>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.</p> <p>Results</p> <p>No statistically significant difference was found between MLU and CLU in the seven key outcomes: caesarean birth (163 [14.8%] <it>vs </it>84 [15.2%]; relative risk (RR) 0.97 [95% CI 0.76 to 1.24]), induction (248 [22.5%] <it>vs </it>138 [25.0%]; RR 0.90 [0.75 to 1.08]), episiotomy (126 [11.4%] <it>vs </it>68 [12.3%]; RR 0.93 [0.70 to 1.23]), instrumental birth (139 [12.6%] <it>vs </it>79 [14.3%]; RR 0.88 [0.68 to 1.14]), Apgar scores < 8 (10 [0.9%] <it>vs </it>9 [1.6%]; RR 0.56 [0.23 to 1.36]), postpartum haemorrhage (144 [13.1%] <it>vs </it>75 [13.6%]; RR 0.96 [0.74 to 1.25]); breastfeeding initiation (616 [55.9%] <it>vs </it>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%] <it>vs </it>313 [56.7%]; RR 0.64 [0.57 to 0.71]), or augmentation of labour (436 [39.6%] <it>vs </it>314 [56.9%]; RR 0.50 [0.40 to 0.61]).</p> <p>Conclusions</p> <p>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.</p> <p>Trial registration number</p> <p>ISRCTN: <a href="http://www.controlled-trials.com/ISRCTN14973283">ISRCTN14973283</a></p>

Item Description

10.1186/1471-2393-11-85
1471-2393