Caseload Midwifery Safe and Cost-Effective for All Women
Fewer elective cesareans and lower costs with caseload care; no difference in neonatal outcomes
TUESDAY, Sept. 17 (HealthDay News) -- For all pregnant women, irrespective of risk factors, caseload midwifery is safe and appears to be cost-effective, according to a study published online Sept. 17 in The Lancet.
Sally K. Tracy, D.Mid., from the University of Sydney, and colleagues conducted an unblinded, randomized, controlled, parallel-group trial to examine the clinical and cost outcomes of caseload midwifery care for women, regardless of risk factors. A total of 1,748 publicly-insured pregnant women were randomized to caseload (871 women) or standard (877 women) care. Caseload care included antenatal, intrapartum, and postnatal care from a named caseload midwife, whereas controls received standard care with rostered midwives.
The researchers found that there was no significant difference in the proportion of cesarean sections between the groups (21 percent in the caseload group versus 23 percent in the standard care group; P = 0.26). The proportion undergoing elective cesarean sections was significantly lower in the caseload versus standard care group (8 versus 11 percent; odds ratio, 0.72). Similar proportions of instrumental births, unassisted vaginal births, and epidural use were seen in the two groups. There was no significant difference in neonatal outcomes between the groups. For caseload midwifery, the total cost of care was AU$566,74 less than for standard care.
"Caseload midwifery care seemed to cost less than standard care, with similar clinical outcomes," the authors write.