Abstract
BackgroundThe maternity care system in the Netherlands is well known for its support of community-based midwifery. However, regular midwifery practices typically do not offer caseload midwifery care – one-to-one continuity of care throughout pregnancy and birth. Because we know very little about the outcomes for women receiving caseload care in the Netherlands, we compared caseload care with regular midwife-led care, looking at maternal and perinatal outcomes, including antenatal and intrapartum referrals to secondary (i.e., obstetrician-led) care.MethodsWe selected 657 women in caseload care and 1954 matched controls (women in regular midwife-led care) from all women registered in the Dutch Perinatal Registry (Perined) who gave birth in 2015. To be eligible for selection the women had to be in midwife-led antenatal care beyond 28 gestational weeks. Each woman in caseload care was matched with three women in regular midwife-led care, using parity, maternal age, background (Dutch or non-Dutch) and region. These two cohorts were compared for referral rates, mode of birth, and other maternal and perinatal outcomes.ResultsIn caseload midwifery care, 46.9% of women were referred to obstetrician-led care (24.2% antenatally and 22.8% in the intrapartum period). In the matched cohort, 65.7% were referred (37.4% antenatally and 28.3% in the intrapartum period). In caseload care, 84.0% experienced a spontaneous vaginal birth versus 77.0% in regular midwife-led care. These patterns were observed for both nulliparous and multiparous women. Women in caseload care had fewer inductions of labour (13.2% vs 21.0%), more homebirths (39.4% vs 16.1%) and less perineal damage (intact perineum: 41.3% vs 28.2%). The incidence of perinatal mortality and a low Apgar score was low in both groups.ConclusionsWe found that when compared to regular midwife-led care, caseload midwifery care in the Netherlands is associated with a lower referral rate to obstetrician-led care – both antenatally and in the intrapartum period – and a higher spontaneous vaginal birth rate, with similar perinatal safety. The challenge is to include this model as part of the current effort to improve the quality of Dutch maternity care, making caseload care available and affordable for more women.
Highlights
The maternity care system in the Netherlands is well known for its support of community-based midwifery
In this study we define caseload midwifery care as a midwife-led continuity of care (MLCC) model in which one-to-one continuity of care throughout pregnancy, childbirth and the postpartum period is guaranteed by a single midwife, with backup provided by a partner midwife and in good collaboration with other professionals
The objective of our study is to contribute to this evaluation by describing the outcomes of caseload midwifery care compared to regular midwifeled care in the Netherlands in terms of maternal and perinatal outcomes, and antenatal and intrapartum referrals to obstetrician-led care
Summary
The maternity care system in the Netherlands is well known for its support of community-based midwifery. Regular midwifery practices typically do not offer caseload midwifery care – one-to-one continuity of care throughout pregnancy and birth. A solid evidence base exists for midwife-led continuity of care (MLCC) models, including caseload midwifery [1,2,3]. In this study we define caseload midwifery care as a MLCC model in which one-to-one continuity of care throughout pregnancy, childbirth and the postpartum period is guaranteed by a single midwife, with backup provided by a partner midwife and in good collaboration with other professionals. Achieving better continuity of care by implementing caseload midwifery has gained attention in various countries and maternity care systems, such as the United Kingdom [4]; Denmark [5]; Sweden [6], Australia [7].
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
