The effect of primary midwife-led care on women's experience of childbirth: Results from the COSMOS randomised controlled trial

Helen L McLachlan, D. A. Forster, M. A. Davey, T. Farrell, Margaret M. Flood, Touran Shafiei, U. Waldenström

Research output: Contribution to journalArticleResearchpeer-review

41 Citations (Scopus)


Objective To determine the effect of primary midwife-led care ('caseload midwifery') on women's experiences of childbirth. 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 care received antenatal, intrapartum and postpartum care from a primary midwife, with some care provided by a 'back-up' midwife. Women in standard care received midwifery-led care with varying levels of continuity, junior obstetric care or community-based medical care. Main outcome measures The primary outcome of the study was caesarean section. This paper presents a secondary outcome, women's experience of childbirth. Women's views and experiences were sought using seven-point rating scales via postal questionnaires 2 months after the birth. Results A total of 2314 women were randomised between September 2007 and June 2010; 1156 to caseload and 1158 to standard care. Response rates to the follow-up questionnaire were 88 and 74%, respectively. Women in the caseload group were more positive about their overall birth experience than women in the standard care group (adjusted odds ratio 1.50, 95% CI 1.22-1.84). They also felt more in control during labour, were more proud of themselves, less anxious, and more likely to have a positive experience of pain. Conclusions Compared with standard maternity care, caseload midwifery may improve women's experiences of childbirth.

Original languageEnglish
Pages (from-to)465-474
Number of pages10
JournalBJOG: an International Journal of Obstetrics and Gynaecology
Issue number3
Publication statusPublished - 1 Feb 2016
Externally publishedYes


  • Birth experience
  • caseload midwifery
  • continuity of care
  • midwife-led care
  • primary midwife care
  • randomised controlled trial

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