[Birth Outcomes in Caseload Midwifery Care: A Retrospective Cohort Study].

Abstract

While international studies highlight the positive impact on birth outcomes associated with caseload midwives, no comprehensive assessment of the Swiss situation has been performed.This study aimed to assess birth outcomes in Swiss hospitals and in low-risk pregnancies in relation to birth care provided by hospital-based staff midwives compared to attending caseload midwives.For this retrospective cohort study, we used data of n=55,518 low-risk births collected between 2018 and 2021 through voluntary data collection in Swiss hospitals. We performed a descriptive analysis as well as non-parametric correlative and logistic regression analysis using SPSS.Women with caseload midwives were more often multiparous than women with hospital-based staff midwives. The adjusted regression analysis showed that care by attending caseload midwives increased the ratio of spontaneous delivery compared to hospital-based staff midwives (83.1% vs. 70.2%, aOR 1.97, p<0.001). The C-section rate was lower in women in the caseload care system (9.2% vs. 16.6%, aOR 0.55, p<0.001) as well as the rate of vacuum extractions (7.6% vs. 13.0%, aOR 0.63, p<0.001). Care by a caseload midwife was associated with fewer interventions during labour and birth in general. Caseload midwives commonly improve birth outcomes compared to hospital-based staff midwives with respect to mitigating presumably unnecessary interventions.