Turnbull D, Holmes A, Shields N, Cheyne H, Twaddle S, Gilmour W H, McGinley M, Reid M, Johnstone I, Geer I, McIlwaine G, Lunan C B
Midwifery Development Unit, Glasgow Royal Maternity Hospital, UK.
Lancet. 1996 Jul 27;348(9022):213-8. doi: 10.1016/s0140-6736(95)11207-3.
Midwife-managed programmes of care are being widely implemented although there has been little investigation of their efficacy. We have compared midwife-managed care with shared care (ie, care divided among midwives, hospital doctors, and general practitioners) in terms of clinical efficacy and women's satisfaction.
We carried out a randomised controlled trial of 1299 pregnant women who had no adverse characteristics at booking (consent rate 81.9%). 648 women were assigned midwife-managed care and 651 shared care. The research hypothesis was that compared with shared care, midwife-managed care would produce fewer interventions, similar (or more favourable) outcomes, similar complications, and greater satisfaction with care. Data were collected by retrospective review of case records and self-report questionnaires. Analysis was by intention to treat.
Interventions were similar in the two groups or lower with midwife-managed care. For example, women in the midwife-managed group were less likely than women in shared care to have induction of labour (146 [23.9%] vs 199 [33.3%]; 95% CI for difference 4.4-14.5). Women in the midwife-managed group were more likely to have an intact perineum and less likely to have had an episiotomy (p = 0.02), with no significant difference in perineal tears. Complication rates were similar. Overall, 32.8% of women were permanently transferred from midwife-managed care (28.7% for clinical reasons, 3.7% for non-clinical reasons). Women in both groups reported satisfaction with their care but the midwife-managed group were significantly more satisfied with their antenatal (difference in mean scores 0.48 [95% CI 0.41-0.55]), intrapartum (0.28 [0.18-0.37]), hospital-based postnatal care (0.57 [0.45-0.70]), and home-based postnatal care (0.33 [0.25-0.42]).
We conclude that midwife-managed care for healthy women, integrated within existing services, is clinically effective and enhances women's satisfaction with maternity care.
尽管对助产士主导的护理项目的效果研究较少，但此类项目正在广泛实施。我们在临床疗效和女性满意度方面，对助产士主导的护理与共享护理（即由助产士、医院医生和全科医生共同提供的护理）进行了比较。
我们对1299名在登记时无不良特征的孕妇进行了一项随机对照试验（同意率81.9%）。648名女性被分配到助产士主导的护理组，651名女性被分配到共享护理组。研究假设是，与共享护理相比，助产士主导的护理会减少干预措施，产生相似（或更有利）的结果、相似的并发症，并提高护理满意度。通过回顾病例记录和自我报告问卷收集数据。分析采用意向性分析。
两组的干预措施相似，或助产士主导的护理组干预措施更少。例如，助产士主导护理组的女性进行引产的可能性低于共享护理组（146例[23.9%]对199例[33.3%]；差异的95%置信区间为4.4 - 14.5）。助产士主导护理组的女性更有可能保持会阴完整，进行会阴切开术的可能性更小（p = 0.02），会阴撕裂情况无显著差异。并发症发生率相似。总体而言，32.8%的女性从助产士主导的护理中转出（28.7%是由于临床原因，3.7%是由于非临床原因）。两组女性均对其护理表示满意，但助产士主导护理组对产前护理（平均得分差异0.48[95%置信区间0.41 - 0.55]）、产时护理（0.28[0.18 - 0.37]）、医院产后护理（0.57[0.45 - 0.70]）和家庭产后护理（0.33[0.25 - 0.42]）的满意度显著更高。
我们得出结论，在现有服务体系内，为健康女性提供的助产士主导护理在临床上是有效的，并且提高了女性对产科护理的满意度。
