Effects of a Midwife-Coordinated Maternity Care Intervention (ChroPreg) vs. Standard Care in Pregnant Women with Chronic Medical Conditions: Results from a Randomized Controlled Trial

Abstract

The proportion of childbearing women with pre-existing chronic medical conditions (CMC) is rising. In a randomized controlled trial, we aimed to evaluate the effects of a midwife-coordinated maternity care intervention (ChroPreg) in pregnant women with CMC. The intervention consisted of three main components: (1) Midwife-coordinated and individualized care, (2) Additional ante-and postpartum consultations, and (3) Specialized known midwives. The primary outcome was the total length of hospital stay (LOS). Secondary outcomes were patient-reported outcomes measuring psychological well-being and satisfaction with maternity care, health utilization, and maternal and infant outcomes. A total of 362 women were randomized to the ChroPreg intervention (n = 131) or Standard Care (n = 131). No differences in LOS were found between groups (median 3.0 days, ChroPreg group 0.1% lower LOS, 95% CI −7.8 to 7%, p = 0.97). Women in the ChroPreg group reported being more satisfied with maternity care measured by the Pregnancy and Childbirth Questionnaire (PCQ) compared with the Standard Care group (mean PCQ 104.5 vs. 98.2, mean difference 6.3, 95% CI 3.0–10.0, p < 0.0001). In conclusion, the ChroPreg intervention did not reduce LOS. However, women in the ChroPreg group were more satisfied with maternity care.

Validação de escala para mensurar a carga de trabalho das parteiras

“…O primeiro fator é referente ao aumento no número de processos agendados, como cesarianas eletivas, versões cefálicas externas e induções ao parto; isso é consistente com a atual pesquisa baseada em evidências. (21,(23)(24)(25) E o segundo fator depende do tipo de paciente atendida, como a etnia subamericana, as nulíparas e as mulheres que apresentam comorbidades médico-obstétricas. Esse aumento da carga de trabalho observado é consistente com os achados de outros estudos, (1,2,8,21,23) pois atualmente enfrentamos um aumento na atenção aos processos crônicos, gerados pelo aumento da gemelaridade, pelo aumento da idade materna, pelos nascimentos prematuros, bem como pelo aumento das técnicas de reprodução assistida.…”

Obstetrician involvement in planned midwife-led births: a cohort study in an obstetric department of a University Hospital in Switzerland

“…Current studies are now focusing on the evaluation of clinical- and cost-effectiveness in midwifery care models for women experiencing complex pregnancy and women with chronic medical conditions [ 20 – 22 ]. In a randomized controlled trial comparing midwife-coordinated maternity care intervention with standard care for women with chronic medical conditions, de Wolff et al found an increased level of satisfaction with maternity care among women who received midwife coordinated maternity care intervention [ 21 ].…”

Determination of Obstetric Violence and Affecting Factors: A Cross‐Sectional Research

“…Healthcare professionals should receive training in respectful and evidence-based childbirth care, and policy frameworks must safeguard women's rights during pregnancy and childbirth. By taking proactive steps to prevent obstetric violence, we can ensure that all women receive the respectful and safe care they deserve during this signi cant life event (32,(37)(38)(39)(40).…”

“…Healthcare professionals should receive training in respectful and evidence-based childbirth care, and policy frameworks must safeguard women's rights during pregnancy and childbirth. By taking proactive steps to prevent obstetric violence, we can ensure that all women receive the respectful and safe care they deserve during this signi cant life event (32,(37)(38)(39)(40).Despite numerous studies worldwide aiming to identify obstetric violence, research in Turkey remains limited.Furthermore, no studies have examined this issue before women are discharged from the hospital. This study aims to explore women's experiences of obstetric violence and the factors in uencing these experiences during childbirth.The research questions are as follows:1.…”