July 26th 2012

Australian study shows continuity of midwifery care reduces caesarean section rates during childbirth, increases satisfaction with birth for women and leads to better health outcomes for babies.

An Australian first, and the world’s largest randomised controlled trial of ‘one to one’, or ‘caseload midwifery’, was published today in the British Journal of Obstetrics and Gynaecology.

The study was led by Associate Professor Helen McLachlan from the La Trobe University and undertaken at the Royal Women’s Hospital in Melbourne, with funding from the National Health and Medical Research Council.

2314 women were randomly assigned to receiving care from a primary ‘known midwife’ who provided pregnancy care, birth care and care following the birth, or to receiving standard care, involving different care providers through the childbearing experience.

Women who received ‘one to one’ midwifery care from a known midwife were significantly more likely to have a normal vaginal birth without medical intervention, go home sooner and to be more satisfied with their care.

Women who received ‘one to one’ midwifery care had 22% fewer caesarean births than women who had standard care, and there was also a 12% reduction in epidural anaesthetic use and a 21% reduction in episiotomy (surgical cut to the perineum).

No infant outcomes favoured standard care, with the babies of women receiving ‘one to one’ midwifery care being 37% less likely to be admitted to a special care or neonatal intensive care nursery for treatment. There was no difference in perinatal mortality.

This study will now be added to the impressive number of international studies (11 in all) published in the Cochrane Systematic Review on continuity of midwifery care, contributing to the highest level of scientific evidence about the benefits to women and babies of ‘one to one’ midwifery care.

Professor Sue Kruske, President of the Australian College of Midwives said, “Every childbearing woman in Australia must now be given the option of continuity of care from a known midwife. Currently only around 5% of Australian women give birth under this ‘gold standard’ model of care. It appears the relationship of trust built between a midwife and woman is key to positive birth outcomes.”

“This relationship appears to build a woman’s trust and confidence before, during and after the birth, helping women have a more positive birth experience,” Associate Professor McLachlan and lead author of the study said.

It is hoped this study motivates policy makers to make important changes in the way they plan services for the delivery of care to childbearing women in the near future.
“If Australia is to reduce its high caesarean section rate then continuity of midwifery care must be the first urgent strategy in any health service reform,” said Professor Kruske.

Media release by the Australian College of Midwives