Effects of continuity of care by a primary midwife (caseload midwifery) on caesarean section rates in women of low obstetric risk: The COSMOS randomised controlled trial

Helen L McLachlan, Della A Forster, Mary-Ann Davey, Tanya Farrell, Lisa Gold, Mary Anne Biro, Leah Albers, Maggie Flood, Jeremy Oats, Ulla Waldenstrom

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Objective: To determine whether primary midwife care (caseload midwifery) decreases the caesarean section rate compared with standard maternity care. Design: Randomised controlled trial. Setting: Tertiary-care women s hospital in Melbourne, Australia. Population: A total of 2314 low-risk pregnant women. Methods: Women randomised to caseload received antenatal, intrapartum and postpartum care from a primary midwife with some care by back-up midwives. Women randomised to standard care received either midwifery or obstetric-trainee care with varying levels of continuity, or community-based general practitioner care. Main outcome measures: Primary outcome: caesarean birth. Secondary outcomes included instrumental vaginal births, analgesia, perineal trauma, induction of labour, infant admission to special/neonatal intensive care, gestational age, Apgar scores and birthweight
Original languageEnglish
Pages (from-to)1483 - 1492
Number of pages10
JournalBJOG: An International Journal of Obstetrics and Gynaecology
Issue number2
Publication statusPublished - 2012

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