Continuity of care by a midwife team versus routine care during pregnancy and birth: a randomised trial

Challenging midwifery care, challenging midwives and challenging the system

“…8 The first randomised controlled trials of continuity of midwifery care date back to the late 1980s 9 and many have followed including a number of Australian trials. [10][11][12][13][14][15] Other research has demonstrated the benefits of one-to-one 16 and caseload models of care. 17 Caseload models have also been shown to be beneficial for midwives, reducing burnout and improving retention.…”

“…The randomised controlled trials on team midwifery showed positive outcomes with teams of six to eight midwives. 9,[11][12][13][14] In many settings in Australia, teams are now made up of 20 or more midwives who work rotating shifts through the maternity unit. It is hard to see how any amount of continuity of carer is possible with teams this size.…”

Economic evaluation of birth care in low-risk women. A comparison between a midwife-led birth unit and a standard obstetric unit within the same hospital in Norway. A randomised controlled trial

“…A randomised controlled trial (RCT) from Australia comparing birth centre care with delivery suite care for low-risk women found no differences related to clinical outcomes or costs (Byrne et al, 2000). Another Australian study comparing care by a midwife team versus routine care for both low-and high-risk women revealed that team care resulted in a cost reduction of 4.5% (Rowley et al, 1995). A third article from Australia presenting a cost analysis comparing community-based continuity of midwifery care versus standard hospital care, found that the mean costs were lower for the community-based continuity of midwifery care even after adjusting for caesarean sections (Homer et al, 2001).…”

“…A third article from Australia presenting a cost analysis comparing community-based continuity of midwifery care versus standard hospital care, found that the mean costs were lower for the community-based continuity of midwifery care even after adjusting for caesarean sections (Homer et al, 2001). Even though these trials are conducted in the same country a comparison is difficult due to varied organisation of birth care and different structure of the trials (Rowley et al, 1995;Byrne et al, 2000;Homer et al, 2001). A study from the USA showed that there were no differences in costs when comparing a freestanding birth centre to "traditional care" in a central New York community, but a sensitivity analysis demonstrated that freestanding birth centres could be cost effective if they increased their volume (Stone et al, 2000).…”

Medicare rebates for midwives: An analysis of the 2009/2010 Federal Budget

“…[6][7][8][9] Under the ANMC National Competency Standards for the Midwife, midwives are equipped with the necessary skills to provide continuity of primary maternity care to women through pregnancy, birth and to 6 weeks postpartum from entry to practice. 10 While some registered midwives may have had limited opportunities to practice to full scope, or may be newly graduated and require support, it is important that the professional development needs of midwives are addressed without re-defining midwifery practice by identifying ''full scope'' as ''advanced practice''.…”