Safety of non-medically led primary maternity care models: a critical review of the international literature

McIntyre, Meredith

doi:10.1071/ah11039

Cited by 22 publications

(16 citation statements)

References 40 publications

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“…30 A review of 22 international non-randomised studies has also shown that low risk women in midwife-led, birth centre or homebirth services in the care of midwives experienced fewer obstetric interventions and were more likely to have a normal birth without complications than low risk women receiving standard hospital or obstetric care. 31 Although these were non-randomised studies, with diverse study designs and models of care, they nevertheless provide additional evidence supporting midwifery continuity of care.…”

Section: Combined Carementioning

confidence: 99%

Models of maternity care: evidence for midwifery continuity of care

Homer

2016

Medical Journal of Australia

148

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There has been substantial reform in the past decade in the provision of maternal and child health services, and specifically regarding models of maternity care. Increasingly, midwives are working together in small groups to provide midwife-led continuity of care. This article reviews the current evidence for models of maternity care that provide midwifery continuity of care, in terms of their impact on clinical outcomes, the views of midwives and childbearing women, and health service costs. A systematic review of midwife-led continuity of care models identified benefits for women and babies, with no adverse effects. Non-randomised studies have shown benefits of midwifery continuity of care for specific groups, such as Aboriginal and Torres Strait Islander women. There are also benefits for midwives, including high levels of job satisfaction and less occupational burnout. Implementing midwifery continuity of care in public and private settings in Australia has been challenging, despite the evidence in its favour and government policy documents that support it. A reorganisation of the way maternity services are provided in Australia is required to ensure that women across the country can access this model of care. Critical to such reform is collaboration with obstetricians, general practitioners, paediatricians and other medical professionals involved in the care of pregnant women, as well as professional respect for the central role of midwives in the provision of maternity care. More research is needed into ways to ensure that all childbearing women can access midwifery continuity of care.

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Section: Combined Carementioning

confidence: 99%

Models of maternity care: evidence for midwifery continuity of care

Homer

2016

Medical Journal of Australia

148

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“…Similar to midwife-led centers, the philosophy of care at the birth care center and support provided by the dedicated nursing staff may have influenced our cesarean rate despite the fact that many of the physicians were the same at both delivery sites. (2–4) Therefore while the ability to provide augmentation, analgesia and procedures is similar to a hospital setting the philosophy of care in this hospital linked birth center is to minimize their use.…”

Section: Discussionmentioning

confidence: 99%

“…(1) The efficacy of this approach in comparison with hospital-based delivery has been evaluated using randomized trials and large cohort studies in Europe, New Zealand, Australia, Canada, the United States and other countries. (2–4) To encourage the best use of resources, birth care centers are geared to the low-risk parturient who would generally be expected to require fewer obstetric interventions. The goal is to provide a safe vaginal birth for both the mother and her infant.…”

Section: Introductionmentioning

confidence: 99%

Physician‐Led, Hospital‐Linked, Birth Care Centers can Decrease Cesarean Section Rates Without Increasing Rates of Adverse Events

O'Hara

Frazier

Stembridge

et al. 2013

Birth

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BACKGROUND This study compares outcomes at a hospital-linked, physician-led, birthing center to a traditional hospital labor and delivery service. METHODS Using de-identified electronic medical records, a retrospective cohort design was employed to evaluate 32,174 singleton births during 1998–2005. RESULTS Compared to hospital service, birth care center delivery was associated with a lower rate of cesarean sections (adjusted Relative Risk =0.73, 95 percent confidence interval 0.59–0.91; p<0.001) without an increased rate of operative vaginal delivery (adjusted Relative Risk=1.04, 95 percent confidence interval 0.97–1.13; p=0.25) and a higher initiation of breast feeding (adjusted Relative Risk = 1.28, 95 percent confidence interval 1.25–1.30 (p=<0.001). A maternal length of stay greater than 72 hours occurred less frequently in the birth care center (adjusted Relative Risk =0.60, 95 percent confidence interval 0.55–0.66; p<0.001). Comparing only women without major obstetrical risk factors, the differences in outcomes were reduced but not eliminated. Adverse maternal and infant outcomes were not increased at the birth care center. CONCLUSION A hospital-linked, physician-led, birth care center has the potential to lower rates of cesarean sections without increasing rates of operative vaginal delivery or other adverse maternal and infant outcomes.

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“…As pregnancy and birth are not illness, a new system with a philosophy based on primary health care principles and practice should replace the current dominant biomedical paradigm (McIntyre, 2012).…”

Section: Section 4: Better Systems Designmentioning

confidence: 99%

“…Models variously named 'caseload midwifery practice', 'midwifery group practice', 'know your midwife', and 'community midwifery' currently exist in isolated sites in most states and territories of Australia, with demand exceeding access and services supply (Hartz et al, 2012a). These primary care models include collaboration with obstetricians and other health professionals as each woman's needs dictate (McCourt & Page, 1996;Biro et al, 2000;Homer et al, 2001;Hodnett et al, 2004;Turnbull et al, 2009;Hartz et al, 2012b;McIntyre, 2012;McLachlan et al, 2012;Tracy et al, 2013). Evaluations show these models to be safe, rated highly by women, and effective in improving work satisfaction and hence retention of midwives.…”

Section: Section 4: Better Systems Designmentioning

confidence: 99%

Identifying better systems design in Australian maternity care: a Boundary Critique analysis

et al. 2013

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This article examines the background and limitations of maternity care policy and provision in Australia using the Boundary Critique method from critical systems thinking. We argue that the historical legacy of funding maternity care within medically dominated fee-for-service structures and acute hospital budgets is seriously flawed. Furthermore, it cannot deliver the policy goals of healthy and socially equitable birth practices. Despite the 2009 national Maternity Services Review and progress of a National Maternity Services Plan (2011), most mainstream Australian maternity services remain out-of-step with both health service research and evidence-based 'best practice'.The present system drives unnecessary clinical interventions, increased expenditure, short-term adverse health outcomes and the potential for a larger, unacknowledged legacy of future chronic disease. By contrast, boundary critique analysis suggests that redesigning for good maternity service provision can act as a population-level preventative health strategy, offering better value, better health and improved equity in maternity care.

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Safety of non-medically led primary maternity care models: a critical review of the international literature

Abstract: Abstract. The Australian government has announced major reforms with the move to a primary maternity care model.

Cited by 22 publications

References 40 publications

Models of maternity care: evidence for midwifery continuity of care

Models of maternity care: evidence for midwifery continuity of care

Physician‐Led, Hospital‐Linked, Birth Care Centers can Decrease Cesarean Section Rates Without Increasing Rates of Adverse Events

Identifying better systems design in Australian maternity care: a Boundary Critique analysis

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