About Birth
Study backs
midwife-led maternity care ...
A Major Study Comparing Midwifery-led and Consultant-led
Maternity Care by the School of Nursing and Midwifery
The University Of Dublin
"The results of this study agree with those from international
research, and the Cochrane review of midwifery-led care concludes
that most women should be offered midwife-led models of care."
Dec 22, 2009
The results of a major study comparing two methods of maternity
care, commissioned by the HSE and conducted by the School of Nursing
and Midwifery, Trinity College Dublin, were presented to the HSE on
Friday December 18th last.
This study involved 1653 women having babies in the HSE
North-Eastern region from 2004 to 2007, and compared the usual
consultant-led maternity care with a new model of care provided by
midwives in two integrated Midwifery-led Units (MLUs) in Our Lady of
Lourdes Hospital, Drogheda and Cavan General Hospital. The two MLUs,
the first such units in Ireland, were opened in response to
recommendations made in the Kinder Report in 2001, to provide more
choice in maternity care in the North East. The study was carried
out with the full support and cooperation of medical and midwifery
staff in both units in the region.
The ‘MidU’ (‘Midwifery Unit’) study showed that midwifery-led care,
as practised in these units, is as safe as consultant-led care but
uses less intervention in pregnancy and childbirth. The number of
babies needing resuscitation at birth, or admission to the special
care baby unit, was the same in both groups. Six out of every ten
women (59%) having the usual care in the consultant-led hospitals (CLUs)
had their baby’s heart beat monitored continuously in labour by an
electronic monitoring machine, compared with 38% of women in the
MLUs.
Almost half of the women in the CLUs (49%) had their labours speeded
up by either having their waters broken or having oxytocin, a
hormone, given intravenously by ‘drip’, compared with a third (34%)
of women in the MLUs.
Emeritus Professor of Obstetrics and Gynaecology, Professor John
Bonnar, in Trinity College Dublin and a member of the Maternity
Services Taskforce set up by the HSE to oversee the implementation
of the Kinder Report in the North East, welcomed the results of this
study. “Midwifery-led care has potential to provide greater choice
for the majority of low-risk women, better continuity of personal
antenatal care and a more satisfying birth experience,” he said.
“Women are also in hospital for a much shorter time and then have
supportive follow-up midwifery care in their homes for the first 7
days. This model of care will enable consultant obstetricians to
devote more time to caring for women with pregnancy complications,
so all women in Ireland gain through this initiative.”
Professor of Midwifery, Cecily Begley, in Trinity College Dublin and
principal investigator of the project said the results demonstrated
the high quality care given by both consultants and midwives in this
country. “Safety is our primary concern”, she said, “and this study
has shown conclusively that low risk women receive safe care from
both midwives and obstetricians. Midwifery-led care uses fewer
interventions, however, and most women prefer that.”
The model of care used in the two MLUs is one where midwives,
working in partnership with the woman, are the lead professional.
They provide care in pregnancy, shared with the woman’s general
practitioner if desired, and refer any problems to the GP or
obstetrician as necessary. When the woman commences labour, she
comes to the MLU, which is a separate unit within the maternity
hospital, and is welcomed into her private room where she stays for
the labour, birth and postnatal resting time. Each room has a bed,
pull-out couch for her partner to sleep on, a birthing pool,
birthing aids, television, and tea/coffee-making facilities
available.
Women’s satisfaction with the facilities was apparent in the study
and 85% of those attending the MLUs said they would recommend the
care they had received to a friend, compared with 70% of those
having usual care. Although facilities in the MLUs were quite
luxurious, the cost of care for each woman was €332.80 less than in
the usual hospital system.
In labour, fewer women in the MLU group chose to have epidurals
(19%) than did those in the CLU (25%). Other methods of pain relief
chosen included immersion in warm water in a birthing pool (24% in
MLU compared with 3% in CLU). Despite having fewer epidurals, 83% of
women in the MLUs expressed satisfaction with their pain relief,
compared with 68% of women in the CLU. “When women are supported by
one-to-one midwifery care, are encouraged to labour gently at their
own pace and have the pain-relieving benefits of relaxing in warm
water, they are far better able to tolerate pain, and labour more
effectively,” said Professor Begley. At birth, women in the MLU had
a higher rate of spontaneous pushing and 20% used upright positions
for birthing compared with 6% in the CLU. In addition, 13% did not
require any drugs to speed up the after-birth, compared with just 1
woman (0.2%) in the CLU.
The results of this study agree with those from international
research, and the Cochrane review of midwifery-led care concludes
that most women should be offered midwife-led models of care. A
recent KPMG report on maternity care in the Greater Dublin Region
also recommended the introduction of midwifery-led units, adjacent
to the obstetric units, so that access to consultant care and
clinical support services is immediately available if required. The
KPMG report concluded that, providing that the midwives in the MLU
are experienced and adhere to guidelines, MLUs can provide a safe
alternative location for low risk mothers to deliver their babies in
addition to the main obstetric unit.
Assistant National Director, Reconfiguration, Fionnuala Duffy,
accepted the report on behalf of the HSE. She stated that this study
was “a carefully implemented, randomised trial comparing
midwifery-led care provided for low risk women in an integrated MLU
using evidence-based policies and procedural guidelines, with
consultant-led care. The results have shown that midwifery-led care,
as practised in this study, is as safe as consultant-led care,
results in less intervention, is viewed by women with greater
satisfaction in some aspects of care and is more cost-effective. “
She said: “This comprehensive MidU study provides further evidence
to support the need for development and expansion of such units as
an integral part of a comprehensive maternity service offering
appropriate range of services for women. The results and
recommendations are very relevant to the HSE in informing the
planning, reconfiguration and delivery of maternity services
nationally. The study findings are also relevant in informing
operational policy in care provision in maternity services. The HSE
will study the detail of the report, share the findings with the
relevant stakeholders and consider the implications for the delivery
of maternity care nationally.”
Click on
banner for the Trinity College Paper
'Behold, I will bring them from the north country, And gather them
from the ends of the earth,
Among them the blind and the lame,
The woman with child and The one who labors with child, together,
A
great throng shall return there...And My people shall be satisfied with My goodness, says the LORD.'
Jeremiah 31:8, 14~~~
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May 2010
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