Main outcome measuresData were collected on onset and outcomes of labour, antenatal, intrapartum and postnatal complications, antenatal admissions to hospital and neonatal mortality and morbidity. ResultsThere was a significant difference in the caesarean section rate between the groups, 13.3% (73/550) in the STOMP group and 17.8% in the control group (96/539). This difference was maintained after controlling for known contributing factors to caesarean section (OR=0.6, 95% CI 0.4-0.9, P=0.02). There were no other significant differences in the events during labour and birth.Eighty (14.5%) neonates from the STOMP group and 102 (18.9%) from the control group were admitted to the special care nursery but this difference was not significant (OR 0.75, 95% CI 0.5-1.1, P=0.12). Eight infants died during the perinatal period (four from each group), for an overall perinatal mortality rate of 7.3 per 1,000 births. 3 ConclusionCommunity-based continuity of maternity care provided by midwives and obstetricians resulted in a significantly reduced caesarean section rate. There were no other differences in clinical outcomes.

Abstract

Perhaps reflecting these qualifications, more managers in 1999 indicated their intention to move to more senior management positions in the next decade. The mode for experience in this role of 1 year in both 1989 and 1999 reflects a worrying trend of high turnover and inexperience amongst this group of managers. While maternity relief might account for this result, further research needs to determine more precise reasons. The ad hoc bases on which expert clinicians (clinical nurse specialists) act as the manager in his/her absence need to be critically examined. Alternative strategies such as introducing a formal second- in-charge position may ensure more successful recruitment and retention of staff to these critical management positions.

Objective To test whether a new community-based model of continuity of care provided by midwives and obstetricians improved maternal clinical outcomes, in particular a reduced caesarean section rate. Design Randomised controlled trial.Setting A public teaching hospital in metropolitan Sydney, Australia.Sample 1089 women randomised to either the community-based model (n 550) or standard hospital-based care (n 539) prior to their ®rst antenatal booking visit at an Australian metropolitan public hospital.Main outcome measures Data were collected on onset and outcomes of labour, antenatal, intrapartum and postnatal complications, antenatal admissions to hospital and neonatal mortality and morbidity. Results There was a signi®cant difference in the caesarean section rate between the groups, 13.3% (73/550) in the community-based group and 17.8% in the control group (96/539). This difference was maintained after controlling for known contributing factors to caesarean section (OR 0.6, 95% CI 0.4±0.9, P 0.02). There were no other signi®cant differences in the events during labour and birth. Eighty babies (14.5%) from the community-based group and 102 (18.9%) from the control group were admitted to the special care nursery, but this difference was not signi®cant (OR 0.75, 95% CI 0.5-1.1, P 0.12). Eight infants died during the perinatal period (four from each group), for an overall perinatal mortality rate of 7.3 per 1000 births.Conclusion Community-based continuity of maternity care provided by midwives and obstetricians resulted in a signi®cantly reduced caesarean section rate. There were no other differences in clinical outcomes.

This paper describes a pilot antenatal education program intended to better prepare couples for the early weeks of lifestyle changes and parenting. Eight weeks after birth, data were collected by questionnaire from 19 couples who participated in a pilot program and from 14 couples who were enrolled in a routine hospital program. Women in the pilot program were significantly more satisfied with their experience of parenthood. Facilitated gender-specific discussion groups formed a key strategy in the pilot program.