Labor outcomes in caseload midwifery compared with standard midwifery care: A cohort study

IF 2.8 3区医学 Q1 NURSING

Birth-Issues in Perinatal Care Pub Date : 2024-08-14 DOI:10.1111/birt.12861

Sarah Hjorth PhD, Anne-Line Brülle MSc, Helle Kristensen RM, Anette Frederiksen RM, Ellen Aagard Nohr PhD

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引用次数: 0

Abstract

Background

Research has shown caseload midwifery to increase the chance of vaginal birth, but this may not be the case in settings with high vaginal birth rates in standard care. This study investigated the association between caseload midwifery and birth mode, labor interventions, and maternal and neonatal outcomes at a large obstetric unit in Denmark.

Methods

Cohort study including medical records on live, singleton births fr om June 2018 until February 2022. Exposure was caseload midwifery care compared with standard midwifery care. The primary outcome was birth mode, and secondary outcomes were other outcomes of labor. Adjusted risk ratios (aRR) with 95% confidence intervals (CI) were estimated by log-binomial regression.

Results

Among 16,110 pregnancies, 3162 pregnancies (19.6%) received caseload midwifery care. Caseload midwifery was associated with fewer planned cesareans (aRR 0.63 [95% CI 0.54–0.74]) and emergency cesareans (aRR 0.86 [95% CI 0.75–0.95]). No differences in labor induction, use of epidural analgesia, oxytocin augmentation, or anal sphincter tears were observed. Caseload midwifery performed more amniotomies (aRR 1.14 [95% CI 1.02–1.27]) and tended to perform more episiotomies (aRR 1.19 [95% CI 0.96–1.48]). Postpartum hemorrhage (aRR 0.90 [95% CI 0.82–0.99]) and low Apgar score were less likely (aRR 0.54 [95% CI 0.37–0.77]), and early discharge more likely (aRR 1.22 [95% CI 1.17–1.28]) in caseload midwifery.

Conclusion

In caseload midwifery care, a higher vaginal birth rate was observed with no increase in adverse outcomes, mainly due to a lower likelihood of planned cesarean. Also, fewer children were born with low Apgar scores.

Abstract Image

查看原文本刊更多论文

个案助产与标准助产护理的分娩结果比较：一项队列研究。

背景：研究表明，按病例进行助产可增加阴道分娩的机会，但在标准护理中阴道分娩率较高的情况下，情况可能并非如此。本研究调查了丹麦一家大型产科医院的助产士接生与分娩方式、分娩干预以及产妇和新生儿预后之间的关系：队列研究包括 2018 年 6 月至 2022 年 2 月期间单胎活产的医疗记录。研究对象为个案助产护理与标准助产护理。主要结果为分娩方式，次要结果为其他分娩结果。通过对数二项式回归估算出调整后风险比（aRR）及95%置信区间（CI）：在 16110 名孕妇中，有 3162 名孕妇（19.6%）接受了定点助产护理。个案助产与较少的计划剖宫产（aRR 0.63 [95% CI 0.54-0.74]）和紧急剖宫产（aRR 0.86 [95% CI 0.75-0.95]）有关。在引产、使用硬膜外镇痛、催产素增强或肛门括约肌撕裂方面未观察到差异。有案例的助产士会进行更多的羊膜切开术（aRR 1.14 [95% CI 1.02-1.27]），并倾向于进行更多的外阴切开术（aRR 1.19 [95% CI 0.96-1.48]）。产后出血（aRR 0.90 [95% CI 0.82-0.99]）和低 Apgar 评分（aRR 0.54 [95% CI 0.37-0.77]）的发生率较低，而有案例的助产士更有可能提前出院（aRR 1.22 [95% CI 1.17-1.28]）：结论：在个案助产护理中，阴道分娩率较高，但不良后果并未增加，这主要是由于计划剖宫产的可能性较低。此外，Apgar 评分较低的新生儿也较少。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Birth-Issues in Perinatal Care 医学-妇产科学

CiteScore

4.10

自引率

4.00%

发文量

审稿时长

>12 weeks

期刊介绍： Birth: Issues in Perinatal Care is a multidisciplinary, refereed journal devoted to issues and practices in the care of childbearing women, infants, and families. It is written by and for professionals in maternal and neonatal health, nurses, midwives, physicians, public health workers, doulas, social scientists, childbirth educators, lactation counselors, epidemiologists, and other health caregivers and policymakers in perinatal care.