Retrospective study of birth outcomes for selected primiparous women receiving standard care at The Canberra Hospital compared with those receiving care through the Canberra Midwifery Program (CMP)

Abstract

The aim of this research is to inform our understanding of the clinical outcomes of selected primiparous women accessing varying maternity models of care at The Canberra Hospital in order to determine best practice and assist future planning: to compare a retrospective cohort of selected primiparous women who have accessed the Canberra Midwifery Program (CMP) with those who received standard public care at The Canberra Hospital. The studywas conducted using data collected from records held by The Canberra Hospital for the period 1 January 2010 to 31 December 2011 and aimed to determine: whether the clinical outcomes for selected primiparous women differ between those women receiving standard public maternity care and those receiving care from a known midwife or midwives in the CMP. The primary outcome of interest is mode of birth (vaginal, assisted vaginal, operative) and the secondary outcomes include; augmentation of labour, postpartum haemorrhage, perineal trauma, 5 minuteApgar score <7, neonatal admission to the Neonatal Intensive Care Unit (NICU), stillbirth/neonatal death, length of hospital stay and breastfeeding within an hour of birth. The statistically significant differences in outcomes include increased rates of spontaneous vaginal birth, reduced analgesic (including narcotic) use in labour and transfer home within twenty four hours for the CMP group. If it is possible to provide evidence that continuity of care/carers improves the spontaneous vaginal birth rate in selected primiparas, it has far-reaching implications not only for the woman and her family but also for the organisation. Having birthed without intervention the first time, her child-bearing future is almost assured and this has physical, psychological and financial implications for her future. Because she is able to go home early in the care of her known midwife, it also has cost saving implications for the organisation.