Comparison of midwife-led and consultant-led care of healthy women at low risk of childbirth complications in the Republic of Ireland: a randomised trial

Begley, Cecily; Devane, Declan; Clarke, Mike; McCann, Colette; Hughes, Patricia; Reilly, M.; Maguire, Roisin; Higgins, Shane; Finan, Alan; Gormally, Siobhan; Doyle, Miriam

doi:10.1186/1471-2393-11-85

Cited by 88 publications

(64 citation statements)

References 23 publications

(37 reference statements)

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“…The frequency of operative vaginal delivery in our trial was lower than the 13 to 14% frequency in the meta-analysis by Schuit et al 20 Operative vaginal delivery is much more common in Europe than in the United States 23 where the current rate is approximately 3%. 24 In addition, two aspects of fetal heart-rate monitoring practice in Europe differ from the practice in the United States; in Europe, there is a slower horizontal scaling (1 cm per minute) on monitors (resulting in a compressed view that potentially affects the interpretation of heart-rate variability), and fetal blood sampling (for confirming or ruling out fetal acidosis) is more common.…”

Section: Discussioncontrasting

confidence: 71%

A Randomized Trial of Intrapartum Fetal ECG ST-Segment Analysis

et al. 2015

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BACKGROUND It is unclear whether using fetal electrocardiographic (ECG) ST-segment analysis as an adjunct to conventional intrapartum electronic fetal heart-rate monitoring modifies intrapartum and neonatal outcomes. METHODS We performed a multicenter trial in which women with a singleton fetus who were attempting vaginal delivery at more than 36 weeks of gestation and who had cervical dilation of 2 to 7 cm were randomly assigned to “open” or “masked” monitoring with fetal ST-segment analysis. The masked system functioned as a normal fetal heart-rate monitor. The open system displayed additional information for use when uncertain fetal heart-rate patterns were detected. The primary outcome was a composite of intrapartum fetal death, neonatal death, an Apgar score of 3 or less at 5 minutes, neonatal seizure, an umbilical-artery blood pH of 7.05 or less with a base deficit of 12 mmol per liter or more, intubation for ventilation at delivery, or neonatal encephalopathy. RESULTS A total of 11,108 patients underwent randomization; 5532 were assigned to the open group, and 5576 to the masked group. The primary outcome occurred in 52 fetuses or neonates of women in the open group (0.9%) and 40 fetuses or neonates of women in the masked group (0.7%) (relative risk, 1.31; 95% confidence interval, 0.87 to 1.98; P = 0.20). Among the individual components of the primary outcome, only the frequency of a 5-minute Apgar score of 3 or less differed significantly between neonates of women in the open group and those in the masked group (0.3% vs. 0.1%, P = 0.02). There were no significant between-group differences in the rate of cesarean delivery (16.9% and 16.2%, respectively; P = 0.30) or any operative delivery (22.8% and 22.0%, respectively; P = 0.31). Adverse events were rare and occurred with similar frequency in the two groups. CONCLUSIONS Fetal ECG ST-segment analysis used as an adjunct to conventional intrapartum electronic fetal heart-rate monitoring did not improve perinatal outcomes or decrease operative-delivery rates. (Funded by the Eunice Kennedy Shriver National Institute of Child Health and Human Development and Neoventa Medical; ClinicalTrials.gov number, NCT01131260.)

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Section: Discussioncontrasting

confidence: 71%

A Randomized Trial of Intrapartum Fetal ECG ST-Segment Analysis

et al. 2015

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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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“…In Ireland, two alongside Midwife-led units (MLU) were introduced in 2004 and evaluated in a randomised controlled trial (RCT) 2004–2007, the MidU trial (ISRCTN14973283) [13]. Pregnant low-risk nulliparous and parous women were included.…”

Section: Introductionmentioning

confidence: 99%

“…They were transferred to the consultant-led unit (CLU) nearby if necessary and at any stage. The results showed that MLU care was as safe as consultant-led care that was provided to the control group [13] but was associated with fewer interventions, like having continuous electronic fetal monitoring or augmentation of labour. Midwife-led care also cost €182 less per woman [14], and resulted in greater satisfaction for some aspects of care [15].…”

Section: Introductionmentioning

confidence: 99%

Midwife-led maternity care in Ireland – a retrospective cohort study

Dencker

Smith

McCann

et al. 2017

BMC Pregnancy Childbirth

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Background: Midwife-led maternity care is shown to be safe for women with low-risk during pregnancy. In Ireland, two midwife-led units (MLUs) were introduced in 2004 when a randomised controlled trial (the MidU study) was performed to compare MLU care with consultant-led care (CLU). Following study completion the two MLUs have remained as a maternity care option in Ireland. The aim of this study was to evaluate maternal and neonatal outcomes and transfer rates during six years in the larger of the MLU sites. Methods: MLU data for the six years 2008-2013 were retrospectively analysed, following ethical approval. Rates of transfer, reasons for transfer, mode of birth, and maternal and fetal outcomes were assessed. Linear-by-Linear Association trend analysis was used for categorical data to evaluate trends over the years and one-way ANOVA was used when comparing continuous variables. Results: During the study period, 3,884 women were registered at the MLU. The antenatal transfer rate was 37.4% and 2,410 women came to labour in the MLU. Throughout labour and birth, 567 women (14.6%) transferred to the CLU, of which 23 were transferred after birth due to need for suturing or postpartum hemorrhage. The most common reasons for intrapartum transfer were meconium stained liquor/abnormal fetal heart rate (30.3%), delayed labour progress in first or second stage (24.9%) and woman's wish for epidural analgesia (15.1%). Of the 1,903 babies born in the MLU, 1,878 (98.7%) were spontaneous vaginal births and 25 (1.3%) were instrumental (ventouse/ forceps). Only 25 babies (1.3%) were admitted to neonatal intensive care unit. All spontaneous vaginal births from the MLU registered population, occurring in the study period in both the MLU and CLU settings (n = 2,785), were compared. In the MLU more often 1-2 midwives (90.9% vs 69.7%) cared for the women during birth, more women had three vaginal examinations or fewer (93.6% vs 79.9%) and gave birth in an upright position (standing, squatting or kneeling) (52.0% vs 9.4%), fewer women had an amniotomy (5.9% vs 25.9%) or episiotomy (3.4% vs 9.7%) and more women had a physiological management of third stage of labour (50.9% vs 4.6%). Conclusions: Midwife-led care is a safe option that could be offered to a large proportion of healthy pregnant women. With strict transfer criteria there are very few complications during labour and birth. Maternity units without the option of MLU care should consider its introduction.

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Comparison of midwife-led and consultant-led care of healthy women at low risk of childbirth complications in the Republic of Ireland: a randomised trial

Cited by 88 publications

References 23 publications

A Randomized Trial of Intrapartum Fetal ECG ST-Segment Analysis

A Randomized Trial of Intrapartum Fetal ECG ST-Segment Analysis

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

Midwife-led maternity care in Ireland – a retrospective cohort study

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