A Randomized, Controlled Trial of Nurse‐Midwifery Care

Harvey, Sheila; Jarrell, John; Brant, Rollin; Stainton, Colleen; Rach, Diane

doi:10.1111/j.1523-536x.1996.tb00473.x

Cited by 94 publications

(90 citation statements)

References 10 publications

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“…22 The results clearly support the effectiveness of the pilot nurse/midwifery programmes, and the authors advocate a more extensive participation of midwives in the Canadian health-care system. We have not incorporated this trial in the meta-analysis because the emphasis of the intervention was on continuity of care up to the postpartum period rather than the testing of the performance of the health-care provider in the antenatal period.…”

Section: Discussionmentioning

confidence: 59%

Who should provide routine antenatal care for low‐risk women, and how often? A systematic review of randomised controlled trials

Khan‐Neelofur

Gülmezoglu

Villar

1998

Paediatric Perinatal Epid

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Summary. Many activities, the timing and the frequency of visits of conventional antenatal care provided to low-risk pregnant women have most often been introduced without proper scientific evaluation. Few trials, to date, have been conducted to evaluate the effectiveness of antenatal care programmes for low-risk women with varied number of antenatal visits and type of care providers. We have performed a systematic review of these randomised controlled trials.Five randomised controlled trials were identified in which the effectiveness of a schedule of reduced number of antenatal visits (n = 12 883) was compared with the existing practice (n = 9438). Four of these trials were carried out in developed countries. The difference in the number of visits between intervention and control arms of the trials was moderate. Only one trial achieved a reduction in the median number of visits, from six in the standard care to four in the intervention group, that could be considered to be of health-care relevance for the study population. No significant differences were observed in the two arms of the trials when low birthweight, small-for-gestational-age, Caesarean section, induction of labour, antepartum haemorrhage and postpartum haemorrhage were considered as outcome measures. However, there was Neither the individual studies nor the review had the statistical power to evaluate mortality outcome variables. When perception of care was assessed, women participating in two trials expressed less satisfaction with frequency of visits in the experimental group. In the London, UK, trial, some women in the reduced number of visits group felt that their expectations were not completely fulfilled. However, an opposite trend was reflected when women were asked for their preference of the type of care for any future pregnancy.We also identified three trials that compared midwife/general practitioner-managed care vs. obstetrician/gynaecologist-led shared care. The results were indicative of similar clinical efficacy of the two groups. However, women's response regarding the continuity of care favoured midwife-led care. From the health economics perspective, there is evidence of cost reduction if antenatal care was provided by staff other than the obstetrician/gynaecologist.The available data demonstrate no significant differences in selected perinatal outcomes for low-risk women receiving care according to a reduced frequency (approximately two visits fewer) of prenatal visits vs. those following the existing practice. However, there are differences in satisfaction with the prenatal care provider and the prenatal care system. There is evidence that a midwife's clinic for provision of antenatal care for low-risk pregnancies is feasible and thereby reduction in costs achievable.

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Section: Discussionmentioning

confidence: 59%

Who should provide routine antenatal care for low‐risk women, and how often? A systematic review of randomised controlled trials

Khan‐Neelofur

Gülmezoglu

Villar

1998

Paediatric Perinatal Epid

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“…Thirteen of the 53 studies [21][22][23][24][25][26][27][28][29][30][31][32][33] compared the care provided by midwives with that provided by doctors working in a team with midwives. On meta-analysis, no significant difference in the antenatal hospitalization rate was found between care provided by midwives alone and that provided by doctors working with midwives (RR: 0.95; 95% CI: 0.79-1.13).…”

Section: Resultsmentioning

confidence: 99%

Quality of care provided by mid-level health workers: systematic review and meta-analysis

Lassi

Cometto

Huicho

et al. 2013

Bull. World Health Organ.

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“…7;9 A trial of 200 women in Canada did demonstrate a significant difference. 10 The total caesarean section rate in the trial was higher than anticipated a priori. In 1997, the elective caesarean section rate at this hospital was 9.2% with a 10.3% emergency caesarean section rate.…”

Section: Reduced Caesarean Section Ratementioning

confidence: 73%

Collaboration in maternity care: a randomised controlled trial comparing community-based continuity of care with standard hospital care

Homer

Davis

Brodie

et al. 2001

British Journal of Obstetrics and Gynaecology

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Main outcome measuresData were collected on onset and outcomes of labour, antenatal, intrapartum and postnatal complications, antenatal admissions to hospital and neonatal mortality and morbidity. ResultsThere was a significant difference in the caesarean section rate between the groups, 13.3% (73/550) in the STOMP group and 17.8% in the control group (96/539). This difference was maintained after controlling for known contributing factors to caesarean section (OR=0.6, 95% CI 0.4-0.9, P=0.02). There were no other significant differences in the events during labour and birth.Eighty (14.5%) neonates from the STOMP group and 102 (18.9%) from the control group were admitted to the special care nursery but this difference was not significant (OR 0.75, 95% CI 0.5-1.1, P=0.12). Eight infants died during the perinatal period (four from each group), for an overall perinatal mortality rate of 7.3 per 1,000 births. 3 ConclusionCommunity-based continuity of maternity care provided by midwives and obstetricians resulted in a significantly reduced caesarean section rate. There were no other differences in clinical outcomes.

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A Randomized, Controlled Trial of Nurse‐Midwifery Care

Abstract: The results clearly support the effectiveness of the pilot nurse-midwifery program and suggest that more extensive participation of midwives in the Canadian health care system is an appropriate use of health care dollars.

Cited by 94 publications

References 10 publications

Who should provide routine antenatal care for low‐risk women, and how often? A systematic review of randomised controlled trials

Who should provide routine antenatal care for low‐risk women, and how often? A systematic review of randomised controlled trials

Quality of care provided by mid-level health workers: systematic review and meta-analysis

Collaboration in maternity care: a randomised controlled trial comparing community-based continuity of care with standard hospital care

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