Can midwife-managed units improve continuity of care?

Abstract

This study aimed to determine whether a midwife-managed programme could improve continuity of care over that achieved by shared care (i.e. care divided between hospital doctors, midwives and GPs). A randomized controlled trial (analysis by intention to treat) was conducted at the Glasgow Royal Maternity Hospital, which compared 648 women allocated to receive midwife-managed care and 651 allocated to receive shared care. The two main study outcomes were continuity of advice and continuity of carer. Data were collected via questions included in self-report questionnaires sent to women's homes at three time periods (response rates ranged from 63.1% to 85.3%) and a case record review. Women in the midwife-managed group reported receiving more consistent advice across all care periods. For example, during antenatal care, 51.0% of women in the midwife group reported receiving consistent advice all of the time, compared with 21.2% of women in the shared-care group (difference [diff] = 29.9%; 95% confidence interval [CI]; 24.1% to 35.6%). Overall, women in the midwife-managed group saw seven fewer care providers (midwife care mean = 10.0 [standard deviation [SD] = 6.3]; shared care mean = 17.1 [SD = 6.1], diff = -7.1; 95% CI; -8.4 to -5.8). At 7 months follow-up, 4.0% of women in the midwife group reported that they had seen too many or far too many staff during their care, compared with 28.3% of women in the shared care group (diff = -24.3%; 95% CI;-30.7% to -17.8%). These results suggest that midwife-managed care programmes can improve continuity of care.