A cost-comparison of midwife-led compared with consultant-led maternity care in Ireland (the MidU study)

Kenny, Christopher; Devane, Declan; Normand, Charles; Clarke, Mike; Howard, Aoife; Begley, Cecily

doi:10.1016/j.midw.2015.06.012

Cited by 43 publications

(41 citation statements)

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“…The results showed that MLU care was as safe as consultant-led care that was provided to the control group [13] but was associated with fewer interventions, like having continuous electronic fetal monitoring or augmentation of labour. Midwife-led care also cost €182 less per woman [14], and resulted in greater satisfaction for some aspects of care [15]. …”

Section: Introductionmentioning

confidence: 99%

Midwife-led maternity care in Ireland – a retrospective cohort study

Dencker

Smith

McCann

et al. 2017

BMC Pregnancy Childbirth

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Background: Midwife-led maternity care is shown to be safe for women with low-risk during pregnancy. In Ireland, two midwife-led units (MLUs) were introduced in 2004 when a randomised controlled trial (the MidU study) was performed to compare MLU care with consultant-led care (CLU). Following study completion the two MLUs have remained as a maternity care option in Ireland. The aim of this study was to evaluate maternal and neonatal outcomes and transfer rates during six years in the larger of the MLU sites. Methods: MLU data for the six years 2008-2013 were retrospectively analysed, following ethical approval. Rates of transfer, reasons for transfer, mode of birth, and maternal and fetal outcomes were assessed. Linear-by-Linear Association trend analysis was used for categorical data to evaluate trends over the years and one-way ANOVA was used when comparing continuous variables. Results: During the study period, 3,884 women were registered at the MLU. The antenatal transfer rate was 37.4% and 2,410 women came to labour in the MLU. Throughout labour and birth, 567 women (14.6%) transferred to the CLU, of which 23 were transferred after birth due to need for suturing or postpartum hemorrhage. The most common reasons for intrapartum transfer were meconium stained liquor/abnormal fetal heart rate (30.3%), delayed labour progress in first or second stage (24.9%) and woman's wish for epidural analgesia (15.1%). Of the 1,903 babies born in the MLU, 1,878 (98.7%) were spontaneous vaginal births and 25 (1.3%) were instrumental (ventouse/ forceps). Only 25 babies (1.3%) were admitted to neonatal intensive care unit. All spontaneous vaginal births from the MLU registered population, occurring in the study period in both the MLU and CLU settings (n = 2,785), were compared. In the MLU more often 1-2 midwives (90.9% vs 69.7%) cared for the women during birth, more women had three vaginal examinations or fewer (93.6% vs 79.9%) and gave birth in an upright position (standing, squatting or kneeling) (52.0% vs 9.4%), fewer women had an amniotomy (5.9% vs 25.9%) or episiotomy (3.4% vs 9.7%) and more women had a physiological management of third stage of labour (50.9% vs 4.6%). Conclusions: Midwife-led care is a safe option that could be offered to a large proportion of healthy pregnant women. With strict transfer criteria there are very few complications during labour and birth. Maternity units without the option of MLU care should consider its introduction.

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Section: Introductionmentioning

confidence: 99%

Midwife-led maternity care in Ireland – a retrospective cohort study

Dencker

Smith

McCann

et al. 2017

BMC Pregnancy Childbirth

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“…Many recent studies have demonstrated the benefits of midwife care during labour and birth 1,2 and recommend that healthy women in spontaneous labour should be attended by midwives 3 . The American College of Obstetricians and Gynecologists, in 2017, recommends using low-interventional approaches, when appropriate, for the intrapartum care of low-risk women in spontaneous labour; these include intermittent auscultation and non-pharmacologic methods of pain relief, positions of comfort and massage or water immersion.…”

Section: Introductionmentioning

confidence: 99%

“…The American College of Obstetricians and Gynecologists, in 2017, recommends using low-interventional approaches, when appropriate, for the intrapartum care of low-risk women in spontaneous labour; these include intermittent auscultation and non-pharmacologic methods of pain relief, positions of comfort and massage or water immersion. They conclude that obstetric-care providers should be familiar with, and consider using, low-interventional approaches for the intrapartum care 2 …”

Section: Introductionmentioning

confidence: 99%

“…It has been demonstrated that many common obstetric practices such as rupture of membranes for induction of labour, routine intrapartum amniotomy, continuous electronic foetal heart-rate monitoring or routine continuous infusion of intravenous fluids and oxytocin augmentation, are of limited benefit [5][6] . The range of and variation in the use of interventions in healthy low-risk women who are cared for in highly-technological birth environments have implications both in economic and health terms [7][8][9][10][11][12] . …”

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Midwives’ contribution to normal childbirth care. Cross-sectional study in public health Settings. MidconBirth Study protocol

Escuriet¹,

García-Lausín²,

Salgado-Poveda³

et al. 2017

Eur J Midwifery

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European Journal of Midwifery of low risk women in spontaneous labour 4 . It has been demonstrated that many common obstetric practices such as rupture of membranes for induction of labour, routine intrapartum amniotomy, continuous electronic foetal heart-rate monitoring or routine continuous infusion of intravenous fluids and oxytocin augmentation, are of limited benefit [5][6] . The range of and variation in the use of interventions in healthy low-risk women who are cared for in highly-technological birth environments have implications both in economic and health terms [7][8][9][10][11][12] . ABSTRACTThis paper presents the Protocol for a multicentre study that seeks to analyse the relationship between midwife care during childbirth and spontaneous vaginal birth. Each participating hospital collects outcome data from a sample of all women birthing, determined according to the number of annual births attended by midwives, in each hospital.Data collected are sociodemographic variables (age, nationality, level of education). Clinical variables collected are onset of labour, augmentation of labour, professional (midwife or obstetrician) providing care in the first and second stage of labour, transfer of care between professionals, mobility during labour, pharmacological and non-pharmacological pain-management methods used, if any, position for birth, mode of birth outcomes, Apgar score at 1 and 5 minutes, birth weight, timing of breastfeeding initiation and breastfeeding rates. The Bologna Score scale items, are evaluated also.The midwife's contribution in the care of normal birth, and the relationship with spontaneous birth (i.e. vaginal birth without the use of instruments) will serve as a basis for further improving the quality of care provided to pregnant women and their families. Phase I of the study ended in January 2017.

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“…adverse effects in comparison with models of care offered by obstetricians or when both midwives and doctors [4,5] share the work. In addition, a reduction in the use of epidural analgesia, fewer episiotomies and instrumental deliveries have been observed during midwife-led care in some settings [6,7].…”

Section: Introductionmentioning

confidence: 99%

Vaginal Delivery Care, Episiotomy Performance and Examination of Severe Perineal Tears: Cross-Sectional Study in 43 Public Hospitals

Escuriet¹,

Pueyo²,

García-Lausín³

et al. 2017

OGIJ

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Submit Manuscript | http://medcraveonline.com This approach became the project for normal birth assistance, gradually introduced into healthcare practice across the region of Catalonia. This work developed via three specific courses of action aimed at improving the infrastructure in maternity wards in hospitals, raising professionals' awareness and promoting women's participation in maternity care. All of these actions are coordinated by the Catalan Ministry of Health in order to involve all stakeholders and achieve greater consensus in promoting a model of normal childbirth care that is based on known recorded services the profile of the professional best practice.In 2013, a maternity care assessment was performed to explore obstetric interventions conducted on singleton, full-term deliveries in all hospitals in 2014 in Catalonia [2]. In our environment care provided at birth in women with normal pregnancy is assumed mostly by midwives, but the exact proportion of births attended by midwives is not known. The assessment revealed, among other things, a downward trend in the performance of episiotomies in public hospitals and, further, no significant increase in the incidence of severe perineal tears [3]. Based on this evaluation, new lines of research were undertaken to respond to aspects of maternal and child health requiring improvement but for which the information needed for planning effective services currently does not exist. It has been shown that midwife-led care during low/medium risk pregnancy, labour, delivery and postpartum is associated with benefits for mothers and newborns, with no Research ArticleObstet Gynecol Int J 2017, 7(6): 00270 AbstractIntroduction: In recent years work has been done in the public health system in Catalonia in order to achieve consensus in promoting a model of normal childbirth care. This study aims to ascertain the proportion of singleton, full-term vaginal non-instrumental births attended in public hospitals for which an episiotomy was performed and the incidence of severe perineal tears. Methodology:Descriptive cross-sectional study of all singleton births between 37 and 41 completed weeks of gestation attended in public hospitals (2013)(2014). Births were grouped into two groups "deliveries with episiotomy" and "deliveries without episiotomy". Hospitals were grouped by level of complexity (I to III -according to the Catalonia health department classification). The relationship between qualitative variables was analysed using a chi-square test and the T-student test was used for quantitative variables; a p value equal to or lower than 0.005 was considered significant. Results: Data were collected from 53770 births. The total percentage of perineal tears was 35.7% and the total of severe tears was 0.8%. No significant differences in the mean proportion of severe perineal tears among different types of hospitals or between the two groups. The regression analysis shows that the birth weight of the newborn is the only variable that increases the risk of experiencing a seve...

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A cost-comparison of midwife-led compared with consultant-led maternity care in Ireland (the MidU study)

Cited by 43 publications

References 11 publications

Midwife-led maternity care in Ireland – a retrospective cohort study

Midwife-led maternity care in Ireland – a retrospective cohort study

Midwives’ contribution to normal childbirth care. Cross-sectional study in public health Settings. MidconBirth Study protocol

Vaginal Delivery Care, Episiotomy Performance and Examination of Severe Perineal Tears: Cross-Sectional Study in 43 Public Hospitals

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