A randomised study of midwifery caseload care and traditional 'shared-care'.

OBJECTIVES

To evaluate caseload midwifery care in comparison to traditional 'shared care'.

DESIGN

Comparative study with area randomisation.

SETTING

District general hospital in England.

MAIN OUTCOME MEASURES

'Known carer at delivery,' 'normal vaginal delivery' and 'obstetric intervention'.

SUBJECTS

All pregnant women delivering in the six areas chosen for the study.

MAIN FINDINGS

A highly significant difference was found between caseload and traditional care groups in terms of level of 'known carer at delivery' (696/770 94.7%; cf. 52/735 (6.7%), p < 0.001). However, no differences in 'normal vaginal delivery' rates were found (542/770 (70%) cf. 509/735 (69%). There were fewer 'obstetric interventions' in the caseload group, particularly epidural analgesia (80/770 (10%) cf. 110/735 (15%) p = 0.01) and oxytocin augmentation (351/77 (46%) cf. 387/735 (53%), p = 0.01). There were no significant differences found in terms of neonatal outcome.

CONCLUSIONS

Caseload midwifery results in high levels of 'known carer at delivery' which appears to be associated with a reduction in augmentation and epidural rates but which were not associated with an increase in normal vaginal delivery rate.