Named midwife care cost effective
Tuesday 17th September 2013, 12:10AM BST.
A plea to “call the midwife” has been made by experts after new research highlighting the benefits of one-to-one care before, during and after childbirth.
Scientists compared the old system of appointing a named midwife to oversee childbirth, and standard maternity care that tends to be shared between different health professionals.
They found that using an individual caseload midwife led to a significant reduction in rates of non-emergency Caesarean section births.
Women under the care of a named midwife were also less likely to experience a spontaneous labour, required lower doses of pain-killing drugs, and suffered less blood loss after birth.
They stayed in hospital for less time than women given standard care, and were more likely to breastfeed their babies.
In addition, employing a caseload midwife led to a cost saving of £333 per woman giving birth.
The study, conducted at two metropolitan teaching hospitals in Australia, randomly assigned almost 2,000 women to standard maternity care or caseload midwifery.
Under caseload midwifery, women were looked after by a named midwife or backup throughout pregnancy and childbirth. The midwife continued to make home visits for up to six weeks after the baby was born.
Midwives delivering standard care were available on a rostered basis and supported by other hospital staff. They did not have the opportunity to form one-to-one relationships with women throughout the duration of their care.
No difference was seen between the two groups in terms of total numbers of Caesareans, use of epidural pain killers, instrument-assisted births, or intensive care admissions.
Professor Sally Tracy, from the University of Sydney, who led the research published in The Lancet medical journal, said: “Caseload midwifery costs roughly 566 Australian dollars (£333) less per women than current maternity care, with similar outcomes for women of any risk, and could play a major part in reducing public health expenditure in countries like the UK and Australia where standard maternity care is shared between different health professionals.”
She added: “The caseload model of midwifery care has been largely overlooked in maternity systems because of a perception that the service will be too expensive and that the model is not safe for complex pregnancies.
“Our results show that in women of any risk caseload midwifery is safe and cost effective.”
Commenting on the findings in The Lancet, Petra ten Hoope-Bender, director of maternity and child health at the Swiss social services institute ICS Integrare in Geneva, said: “A health system that makes caseload midwifery services available to all women would provide the right services to the right women at the right time. Such an approach can reduce unnecessary interventions, iatrogenic (surgical instrument) harm, deaths, and costs. It can also strengthen the health and well-being of women, the start of the early years of a child’s life, and the capabilities of women to take care of their families and themselves.”
Cathy Warwick, chief executive of the Royal College of Midwives, said the findings added to a recent review of research evidence which showed improved outcomes when women received continual care from a midwife or small midwifery team.
She added: ” In the last national survey of women’s experiences of maternity care in England in 2010, 75% of women had not met any of the staff who cared for them during their labour and birth before. Also 43% of women did not see the same midwife every time or almost every time during pregnancy.
“The Government has made a commitment to women receiving better continuity of care. This evidence confirms that if we want to provide women with the highest possible quality of care commissioners and providers must work together to ensure this commitment is met.”
Minister for Health and Maternity Dr Dan Poulter said: “Investing in maternity care is a top priority for the government – there are now over 1,300 more midwives in the NHS than in 2010 and a record 5,000 in training.
“We are working hard to make sure a named midwife is available for every woman across the country, and the increased number of midwives will help make this a reality for more women.”