Getting the first birth right: A retrospective study of outcomes for low-risk primiparous women receiving standard care versus midwifery model of care in the same tertiary hospital
| Autor: | Jenny Browne, Deborah Davis, Nola Wong, Jan Taylor, Sally A. Ferguson |
|---|---|
| Rok vydání: | 2015 |
| Předmět: |
Postnatal Care
medicine.medical_specialty medicine.medical_treatment Population Psychological intervention Midwifery Cohort Studies Tertiary Care Centers Pregnancy Maternity and Midwifery medicine Childbirth Humans Caesarean section education Retrospective Studies education.field_of_study Obstetrics business.industry Cesarean Section Infant Newborn Parturition Obstetrics and Gynecology Retrospective cohort study Extraction Obstetrical Prenatal Care Odds ratio Continuity of Patient Care Delivery Obstetric Parity Episiotomy Cohort Female Birth Order business Cohort study |
| Zdroj: | Women and birth : journal of the Australian College of Midwives. 28(4) |
| ISSN: | 1878-1799 |
| Popis: | Background There is national and international concern for increasing obstetric intervention in childbirth and rising caesarean section rates. Repeat caesarean section is a major contributing factor, making primiparous women an important target for strategies to reduce unnecessary intervention and surgeries in childbirth. Aim The aim was to compare outcomes for a cohort of low risk primiparous women who accessed a midwifery continuity model of care with those who received standard public care in the same tertiary hospital. Methods A retrospective comparative cohort study design was implemented drawing on data from two databases held by a tertiary hospital for the period 1 January 2010 to 31 December 2011. Categorical data were analysed using the chi-squared statistic and Fisher's exact test. Continuous data were analysed using Student's t -test. Comparisons are presented using unadjusted and adjusted odds ratios, with 95% confidence intervals (CIs) and p -values with significance set at 0.05. Results Data for 426 women experiencing continuity of midwifery care and 1220 experiencing standard public care were compared. The study found increased rates of normal vaginal birth (57.7% vs. 48.9% p = 0.002) and spontaneous vaginal birth (38% vs. 22.4% p = p = 0.050) and caesarean sections (18.8% vs. 22.5% p = 0.115) in the midwifery continuity cohort. There were also fewer interventions in this group. No differences were found in neonatal outcomes. Conclusion Strategies for reducing caesarean section rates and interventions in childbirth should focus on primiparous women as a priority. This study demonstrates the effectiveness of continuity midwifery models, suggesting that this is an important strategy for improving outcomes in this population. |
| Databáze: | OpenAIRE |
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