University College of Northern Denmark, Selma Lagerløfs Vej 2, 9220, Aalborg Øst, Denmark.
Clinical Nursing Research, Aalborg University Hospital, Sdr. Skovvej 15, 9000, Aalborg, Denmark.
BMC Pregnancy Childbirth. 2018 Dec 6;18(1):481. doi: 10.1186/s12884-018-2090-9.
Research on caseload midwifery in a Danish setting is missing. This cohort study aimed to compare labour outcomes in caseload midwifery and standard midwifery care.
A historical register-based cohort study was carried out using routinely collected data about all singleton births 2013-2016 in two maternity units in the North Denmark Region. In this region, women are geographically allocated to caseload midwifery or standard care, as caseload midwifery is only available in some towns in the peripheral part of the uptake areas of the maternity units, and it is the only model of care offered here. Labour outcomes of 2679 all-risk women in caseload midwifery were compared with those of 10,436 all-risk women in standard midwifery care using multivariate linear and logistic regression analyses.
Compared to women in standard care, augmentation was more frequent in caseload women (adjusted odds ratio (aOR) 1.20; 95% CI 1.06-1.35) as was labour duration of less than 10 h (aOR 1.26; 95% CI 1.13-1.42). More emergency caesarean sections were observed in caseload women (aOR 1.17; 95% CI 1.03-1.34), but this might partly be explained by longer distance to the maternity unit in caseload women. When caseload women were compared to women in standard care with a similar long distance to the hospital, no difference in emergency caesarean sections was observed (aOR 1.04; 95% CI 0.84-1.28). Compared to standard care, infants of caseload women more often had Apgar ≤7 after 5 min. (aOR 1.57; 95% CI 1.11-2.23) and this difference remained when caseload women were compared to women with similar distance to the hospital. For elective caesarean sections, preterm birth, induction of labour, dilatation of cervix on admission, amniotomy, epidural analgesia, and instrumental deliveries, we did not obseve any differences between the two groups. After birth, caseload women more often experienced no laceration (aOR 1.17; 95% CI 1.06-1.29).
For most labour outcomes, there were no differences across the two models of midwifery-led care but unexpectedly, we observed slightly more augmentation and adverse neonatal outcomes in caseload midwifery. These findings should be interpreted in the context of the overall low intervention and complication rates in this Danish setting and in the context of research that supports the benefits of caseload midwifery. Although the observational design of the study allows only cautious conclusions, this study highlights the importance of monitoring and evaluating new practices contextually.
丹麦缺乏有关病例助产的研究。本队列研究旨在比较病例助产和标准助产护理的分娩结果。
使用常规收集的 2013 年至 2016 年在丹麦北地区两个产科单位的所有单胎分娩数据，进行了一项基于历史记录的队列研究。在该地区，根据地理位置将妇女分配到病例助产或标准护理，因为病例助产仅在产科单位服务区域的周边城镇提供，并且是这里唯一提供的护理模式。使用多变量线性和逻辑回归分析比较了 2679 名高危病例助产妇女和 10436 名高危标准助产护理妇女的分娩结果。
与标准护理组的妇女相比，病例助产组妇女更常使用催产素（调整后的优势比[aOR]1.20；95%置信区间[CI]1.06-1.35），且产程小于 10 小时的比例更高（aOR 1.26；95% CI 1.13-1.42）。病例助产组妇女的急诊剖宫产率更高（aOR 1.17；95% CI 1.03-1.34），但这可能部分归因于病例助产组妇女距离产科单位较远。当病例助产组妇女与距离医院相似的标准护理组妇女进行比较时，急诊剖宫产率没有差异（aOR 1.04；95% CI 0.84-1.28）。与标准护理相比，病例助产组妇女的婴儿在 5 分钟后 Apgar 评分≤7 的情况更为常见（aOR 1.57；95% CI 1.11-2.23），而当病例助产组妇女与距离医院相似的妇女进行比较时，这种差异仍然存在。对于选择性剖宫产、早产、引产、入院时宫颈扩张、人工破膜、硬膜外镇痛和器械分娩，我们在两组之间没有观察到任何差异。分娩后，病例助产组妇女的会阴侧切发生率较低（aOR 1.17；95% CI 1.06-1.29）。
对于大多数分娩结果，两种助产模式之间没有差异，但出乎意料的是，我们观察到病例助产的催产素使用和不良新生儿结局略多。这些发现应结合丹麦这一背景下的低干预和低并发症率以及支持病例助产益处的研究来解释。尽管研究的观察性设计仅允许谨慎得出结论，但本研究强调了在背景下监测和评估新实践的重要性。
