None listed
Conditions
Brief summary
Restructuring maternity services to introduce caseload midwifery care involves radical changes to the organisation of conventional or routine midwifery and obstetric practices. All these changes make an impact on health planning and the allocation of finite resources. Many innovations are introduced in a relative policy vacuum. Models of maternity care are no exception. In addition to evidence on the experiences of women receiving caseload midwifery care and the experiences of obstetricians and midwives offering caseload care, the outcomes of the proposed trial will contribute: 1. Level 1 evidence of the safety and effectiveness of having a known caseload midwife for the continuum of pregnancy birth and postnatally. 2. Level 1 evidence of the safety and effectiveness of caseload midwifery care for women of all risk. 3. Level 1 evidence on the cost effectiveness of caseload midwifery care and routine obstetric care for all women. 4. ‘Australian randomised controlled trial data to the Cochrane systematic review of midwife led care.
Interventions
Caseload midwifery care:
Women allocated to the caseload intervention will receive antenatal, intrapartum and postpartum care from a primary caseload midwife with one or two antenatal visits to be conducted by a ‘backup’ midwife. Caseload midwives work in group practices of four full time midwives each working a cycle of 152 hours during each four week period. The primary midwife is on call for the woman’s labour and birth except in designated circumstances such as annual leave; sick leave; havi
Caseload midwifery care: Women allocated to the caseload intervention will receive antenatal, intrapartum and postpartum care from a primary caseload midwife with one or two antenatal visits to be conducted by a ‘backup’ midwife. Caseload midwives work in group practices of four full time midwives each working a cycle of 152 hours during each four week period. The primary midwife is on call for the woman’s labour and birth except in designated circumstances such as annual leave; sick leave; having more than one woman in labour; or if it is on one of the two days per week that the primary midwife is scheduled to not work or be on call. Care will then be provided by a back-up midwife. The primary midwife will collaborate with obstetricians and other health professionals as necessary, and will continue to provide caseload care in addition to care provided by obstetricians if complications develop. In addition to providing care until after the birth of the baby, the primary midwife (or a back up midwife) will attend the hospital on most days to provide some postnatal care and will provide domiciliary care following discharge from hospital. Care will be provided according to hospital guidelines and protocols for up to six weeks following birth.
Sponsors
The University of Sydney
Study design
Allocation
Randomised controlled trial
Intervention model
Parallel
Primary purpose
Treatment
Masking
Open (masking not used)
Eligibility
Sex/Gender
All
Age
18 Years to No maximum
Healthy volunteers
Yes
Inclusion criteria
Women will be eligible for trial entry if they are less than 24 completed weeks of pregnancy at booking in
Exclusion criteria
Women will be excluded from the trial if they 18 years or younger and are electively booked to give birth via caesarean section at the time of booking in; or are already booked with a named care provider at the time of booking (Obstetrician/GP/midwife).
Outcome results
None listed