Abstract
BackgroundThe way in which maternity care is provided affects perinatal outcomes for pregnant adolescents; including the likelihood of preterm birth. The study purpose was to assess the feasibility of recruiting pregnant adolescents into a randomised controlled trial, in order to inform the design of an adequately powered trial which could test the effect of caseload midwifery on preterm birth for pregnant adolescents.MethodsWe recruited pregnant adolescents into a feasibility study of a prospective, un-blinded, two-arm, randomised controlled trial of caseload midwifery compared to standard care. We recorded and analysed recruitment data in order to provide estimates to be used in the design of a larger study.ResultsThe proportion of women aged 15–17 years who were eligible for the study was 34% (n=10), however the proportion who agreed to be randomised was only 11% (n = 1). Barriers to recruitment were restrictive eligibility criteria, unwillingness of hospital staff to assist with recruitment, and unwillingness of pregnant adolescents to have their choice of maternity carer removed through randomisation.ConclusionsA randomised controlled trial of caseload midwifery care for pregnant adolescents would not be feasible in this setting without modifications to the research protocol. The recruitment plan should maximise opportunities for participation by increasing the upper age limit and enabling women to be recruited at a later gestation. Strategies to engage the support of hospital-employed staff are essential and would require substantial, and ongoing, work. A Zelen method of post-randomisation consent, monetary incentives and ‘peer recruiters’ could also be considered.
Highlights
The way in which maternity care is provided affects perinatal outcomes for pregnant adolescents; including the likelihood of preterm birth
The primary objective of the PRAMS trial will be to determine whether the proportion of pregnant adolescents experiencing preterm birth less than 37 weeks gestation is similar for those receiving Midwifery group practice (MGP) care and those receiving standard care
Eligible women received the routine letter of hospital acceptance and a brochure describing models of maternity care; with the addition of a Midwives at New Group practice Options (M@non-government organisation (NGO)) trial brochure
Summary
The way in which maternity care is provided affects perinatal outcomes for pregnant adolescents; including the likelihood of preterm birth. The effects of social deprivation on pregnant adolescents are cumulative and multifactorial; they directly affect perinatal outcomes including preterm birth [7] These include smoking, alcohol and illicit drug use [8,18,19], family violence and/or intimate partner violence [20,21,22], social isolation [23,24], mental health issues including depression [8,25,26], poor nutrition and inadequate weight gain during pregnancy [25], genitourinary infection [27,28], and severe psychosocial stressors including low income, unemployment and housing issues [29] or homelessness [30]. Both non-attendance and under-attendance of antenatal care are independently associated with poor perinatal outcomes including preterm birth [15,32]
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