Caseload Midwifery Research Articles

Cystic fibrosis and caseload midwifery

Midwives must provide woman-centred, holistic care for the diverse UK childbearing population. As the NHS moves to adopt the recommendations made in the ‘Better Births’ report, is there an argument to invest in protected caseload midwifery contacts for women with cystic fibrosis? Caseload midwifery refers to a continuity model where a small team of midwives provide care throughout the antenatal, intrapartum and postnatal continuum. Cystic fibrosis affects multiple organ systems and requires specialist medical management during pregnancy. Living with cystic fibrosis has many psychosocial implications and pregnancy presents additional challenges. Health and wellbeing outcomes are improved when individuals are treated holistically in the non-pregnant population; therefore, during pregnancy, birth and postnatally, caseload midwifery may provide a legitimate intervention to improve health outcomes in pregnant women with cystic fibrosis.

Can birth outcome inequality be reduced using targeted caseload midwifery in a deprived diverse inner city population? A retrospective cohort study, London, UK

Objectives(1) To report maternal and newborn outcomes of pregnant women in areas of social deprivation in inner city London. (2) To compare the effect of caseload midwifery with standard care...

Job satisfaction and sustainability of midwives working in caseload models of care: An integrative literature review

BackgroundDemand for caseload midwifery care continues to outstrip supply. We know little about what sustains midwives working in caseload models of care. AimThis review systematically identifies and synthesises research findings reporting on factors which contribute to job satisfaction, and therefore the sustainability of practice, of midwives working in caseload models of care. MethodsA comprehensive search strategy explored the electronic databases CINAHL Plus with Full Text, MEDLINE, PubMED, Cochrane Database of Systematic Reviews, and Scopus. Articles were assessed using the Crowe Critical Appraisal Tool. Data analysis and synthesis of these publications were conducted using a narrative synthesis approach. FindingsTwenty-two articles were reviewed. Factors which contribute to the job satisfaction and sustainability of practice of midwives working in caseload models are: the ability to build relationships with women; flexibility and control over own working arrangements; professional autonomy and identity; and, organisational and practice arrangements. ConclusionInsights into the factors which contribute to the job satisfaction and sustainability of practice of midwives in caseload models of care enables both midwives and healthcare administrators to more effectively implement and support midwifery-led caseload models of care which have been shown to improve outcomes for childbearing women.

Measuring organizational readiness for implementing change (ORIC) in a new midwifery model of care in rural South Australia

BackgroundThe sustainability of Australian rural maternity services is under threat due to current workforce shortages. In July 2019, a new midwifery caseload model of care was implemented in rural South Australia to provide midwifery continuity of care and promote a sustainable workforce in the area. The model is unique as it brings together five birthing sites connecting midwives, doctors, nurses and community teams. A critical precursor to successful implementation requires those working in the model be ready to adopt to the change. We surveyed clinicians at the five sites transitioning to the new model of care in order to assess their organizational readiness to implement change.MethodsA descriptive study assessing readiness for change was measured using the Organizational Readiness for Implementing Change scale (ORIC). The 12 item Likert scale measures a participant’s commitment to change and change efficacy. All clinicians working within the model of care (midwives, nurses and doctors) were invited to complete an e-survey.ResultsOverall, 55% (56/102) of clinicians participating in the model responded. The mean ORIC score was 41.5 (range 12–60) suggesting collectively, midwives, nurses and doctors began the new model of care with a sense of readiness for change. Participants were most likely to agree on the change efficacy statements, “People who work here feel confident that the organization can get people invested in implementing this change and the change commitment statements “People who work here are determined to implement this change”, “People who work here want to implement this change”, and “People who work here are committed to implementing this change.ConclusionResults of the ORIC survey indicate that clinicians transitioning to the new model of care were willing to embrace change and commit to the new model. The process of organizational change in health care settings is challenging and a continuous process. If readiness for change is high, organizational members invest more in the change effort and exhibit greater persistence to overcome barriers and setbacks. This is the first reported use of the instrument amongst midwives and nurses in Australia and should be considered for use in other national and international clinical implementation studies.

Caseload midwifery in a rural Australian setting: A qualitative descriptive study.

INTRODUCTIONMidwifery-led continuity of care models are beneficial to women and babies, but might be challenging for midwives. Several studies have, however, shown that midwives report higher job satisfaction and less burnout when working with caseload. Another challenge is to staff such models in rural areas. The aim of this study was to describe midwives’ experiences of working in a caseload model in a rural region of Australia.METHODSA qualitative descriptive approach using interviews and thematic analysis was undertaken with eleven midwives.RESULTSThe overarching theme, ‘A modified caseload model of care in rural Australia creates opportunities for increased job satisfaction despite the challenges involved with being on call’, comprised: two themes, ‘Increased job satisfaction’ and ‘Challenges’; one core theme, ‘Being on call’; and several subthemes. Working with caseload creates job satisfaction and increases vitality and positive feelings about being a midwife. The main difficulty, as well as the necessity with this model, is the challenging aspect of being on call.CONCLUSIONSCaseload midwifery builds partnership between the woman and her midwife, it allows flexible working hours and increased autonomy, even when the work affects the midwife’s social life. Being on call allows the midwife to work on the whole scope of midwifery practice and is a basis for the continuity model of care; however, being on call also represents a challenge to be overcome in order to make caseload work. Continuity models may be a means to attract midwives to work in rural areas.

Part-time positions in Caseload Midwifery Group Practice: Impact on satisfaction and quality of care

BackgroundCaseload continuity of care models of midwifery are associated with benefits for both mothers and babies. For midwifery staff, caseload models offer flexibility, supportive work partnerships, and one-to-one care with women. However, most caseload models require midwives to be employed 0.7 full-time equivalent or more. AimTo evaluate the satisfaction of women and staff with 0.5 full-time equivalent part-time caseload midwifery group practice care. MethodsA mixed-methods survey study was undertaken. Women, part-time and full-time caseload midwifery staff completed an online survey regarding their experiences. Descriptive statistics were calculated and thematic analysis of qualitative responses was undertaken. FindingsWomen were highly satisfied with the part-time model of care. They indicated a number of advantages including excellent support, flexibility, and responsiveness in receiving care from two primary midwives. Similarly, caseload team midwives were satisfied with the part-time model and valued the flexibility that it offers. Improved coverage of hours and being part of a workplace that promoted work-life balance were perceived as key advantages of having part-time staff in the caseload team. DiscussionThe part-time model facilitated continuity of care and was received positively by women. For staff, part-time roles enhanced work satisfaction and reduced burnout. Most staff encouraged greater expansion of part-time roles. Organisations may reduce midwife burnout and associated costs by implementing part-time roles to support work-life balance and staff satisfaction. ConclusionPart-time caseload midwifery models offered greater flexibility and work-life-balance for staff compared to full-time models and were well received by women.

Women\u2019s characteristics and care outcomes of caseload midwifery care in the Netherlands: a retrospective cohort study

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.

Midwives’ views of caseload midwifery – comparing the caseload and non-caseload midwives’ opinions. A cross-sectional survey of Australian midwives.

BackgroundMidwife-led continuity of care has substantial benefits for women and infants and positive outcomes for midwives, yet access to these models remains limited. Caseload midwifery is associated with professional satisfaction and lower burnout, but also impacts on work-life boundaries. Few studies have explored caseload midwifery from the perspective of midwives working in caseload models compared to those in standard care models, understanding this is critical to sustainability and upscaling. AimTo compare views of caseload midwifery – those working in caseload models and those in standard care models in hospitals with and without caseload. MethodsA national cross-sectional survey of midwives working in Australian public hospitals providing birthing services. FindingsResponses were received from 542/3850 (14%) midwives from 111 hospitals – 20% worked in caseload, 39% worked in hospitals with caseload but did not work in the model, and 41% worked in hospitals without caseload. Regardless of exposure, midwives expressed support for caseload models, and for increased access to all women regardless of risk. Fifty percent of midwives not working in caseload expressed willingness to work in the model in the future. Flexibility, autonomy and building relationships were positive influencing factors, with on-call work the most common reason midwives did not want to work in caseload. ConclusionsThere was widespread support for and willingness to work in caseload. The findings suggest that the workforce could support increasing access to caseload models at existing and new caseload sites. Exposure to the model provides insight into understanding how the model works, which can positively or negatively influence midwives’ views.

Women's unmet needs in early labour: Qualitative analysis of free-text survey responses in the M@NGO trial of caseload midwifery

Objectiveto analyse women's experiences of early labour care in caseload midwifery in Australia. Designthis study sits within a multi-site randomised controlled trial of caseload midwifery versus standard care. Participant surveys were conducted at 6-weeks and 6-months after birth. Free-text responses about experiences of care were subject to critical thematic analysis in NVivo 11 software. Settingtwo urban Australian hospitals in different states. Participantswomen 18 years and over, with a singleton pregnancy, less than 24 weeks’ pregnant, not planning a caesarean section or already booked with a care provider; were eligible to participate in the trial. Interventionsparticipants were randomised to caseload midwifery or standard care for antenatal, labour and birth and postpartum care. Measurements and findingsThe 6-week survey response rate was 58% (n = 1,019). The survey included five open questions about women's experiences of pregnancy, labour and birth, and postnatal care. Nine-hundred and one respondents (88%) provided free text comments which were coded to generate 10 categories. The category of early labour contained data from 84 individual participants (caseload care n = 44; standard care n = 40). Descriptive themes were: (1) needing permission; (2) doing the ‘wrong’ thing; and (3) being dismissed. Analytic themes were: (1) Seeking: women wanting to be “close to those who know what's going on”; and (2) Shielding: midwives defending resources and normal birth. Key conclusionsRegardless of model of care, early labour care was primarily described in negative terms. This could be attributed to reporting bias, because women who were neutral about early labour care may not comment. Nevertheless, the findings demonstrate a gap in knowledge about early labour care in caseload midwifery models. Implications for practiceMaternity services that offer caseload midwifery are ideally placed to evaluate how early labour home visiting impacts women's experiences of early labour.

A modified caseload midwifery model for women with fear of birth, women’s and midwives’ experiences: A qualitative study

ObjectiveAlthough fear of birth is common during pregnancy and childbirth, the best treatment for fear of birth in clinical care remain unclear. Strong evidence suggests that continuity models of midwifery care can benefit women and birth outcomes, though such models are rare in Sweden. Because women with fear of birth could benefit from such models, the aim of this qualitative study was to examine how women with fear of birth and their midwives experienced care in a modified caseload midwifery model. MethodsA qualitative interview study using thematic analysis. Participants were recruited from a pilot study in which women assessed to have fear of birth received antenatal and intrapartum care, from a midwife whom they knew. Eight women and four midwives were interviewed. ResultsAn overarching theme—“A mutual relationship instilled a sense of peace and security”—and three themes—“Closeness, continuity, and trust,” “Preparation and counselling,” and “Security, confidence, and reduced fear”—reflect the views and experiences of women with fear of birth and their midwives after participating in a modified caseload midwifery model. ConclusionsFor both women with fear of birth and their midwives, the caseload midwifery model generated trustful woman–midwife relationships, which increased women’s confidence, reduced their fear, and contributed to their positive birth experiences. Moreover, the midwives felt better equipped to address women’s needs, and their way of working with the women became more holistic. Altogether, offering a continuity model of midwifery care could be an option to support women with fear of birth.

Reducing caesarean delivery: An economic evaluation of routine induction of labour at 39 weeks in low-risk nulliparous women.

Clinical interventions known to reduce the risk of caesarean delivery include routine induction of labour at 39weeks, caseload midwifery and chart audit, but they have not been compared for cost-effectiveness. To assesses the cost-effectiveness of three different interventions known to reduce caesarean delivery rates compared to standard care; and conduct a budget impact analysis. A Markov microsimulation model was constructed to compare the costs and outcomes produced by the different interventions. Costs included all costs to the health system, and outcomes were quality-adjusted life years (QALY) gained. A budget impact analysis was undertaken using this model to quantify the costs (in Australian dollars) over three years for government health system funders. All interventions, plus standard care, produced similar health outcomes (mean of 1.84 QALYs gained over 105weeks). Caseload midwifery was the lowest cost option at $15587 (95% confidence interval [CI] 15269, 15905), followed by routine induction of labour ($16257, 95% CI 15989, 16536), and chart audit ($16325, 95% CI 15979, 16671). All produced lower costs on average than standard care ($16905, 95% CI 16551, 17259). Caseload midwifery would produce the greatest savings of $172.6 million over three years if implemented for all low-risk nulliparous women in Australia. Caseload midwifery presents the best value for reducing caesarean delivery rates of the options considered. Routine induction of labour at 39weeks and chart audit would also reduce costs compared to standard care.

Expanding a midwifery caseload model within a large tertiary service

Exposure to alcohol prenatally can result in a child being diagnosed with fetal alcohol spectrum disorder. Affected infants experience lifelong impairments that can involve, physical, cognitive, behavioural and emotional difficulties that impact on their functional capacity. Effective prevention of fetal alcohol spectrum disorder is critically needed in Australia. Reduction in the prevalence of this disorder will only be possible if we prevent alcohol consumption during pregnancy.This paper provides an overview of fetal alcohol spectrum disorder and discusses the role of caseload midwifery as part of a multi-level prevention approach.Drawing on previous research, caseload midwifery has potential to support the prevention of fetal alcohol spectrum disorder through continuity of care.Prevention of fetal alcohol spectrum disorder will be more likely if women experience a supportive relationship with a known midwife, who has received appropriate training and can enable women to feel comfortable in discussing and addressing alcohol use.

Implementation and upscaling of midwifery continuity of care: The experience of midwives and obstetricians

ProblemDespite high quality evidence supporting midwifery continuity of care, access to this model is limited in many parts of Australia and internationally. BackgroundThe models of care provided to women have a strong influence on their perinatal experience and clinical outcomes. Midwifery Continuity of Care (CoC) is arguably the most significant factor in enhancing women’s clinical outcomes during child-bearing and facilitating a positive childbirth experience. Health system change is required, yet little literature has detailed the actualisation of this in the context of upscaling midwifery CoC. Research question/aimThis study aimed to explore the perceptions and experiences of midwifery and obstetric staff during the implementation and upscaling of midwifery CoC within a regional hospital and health service in coastal Queensland, Australia. MethodsA single-site, qualitative enquiry. Obstetricians and midwives participated in semi-structured interviews or focus groups at two-time points: within 2 months of introduction of the CoC service (obstetricians n=6; midwives n=15); and 2-years after implementation (obstetricians n=5; midwives n=17). Data were analysed thematically. FindingsFour key themes and several categories were generated from the data: hopes and expectations; clinical and practice changes; organisational and structural change; and, future directions. DiscussionOrganisational culture, structural change, communication processes and collaborative relationships can be used to inform future scale-up and sustain midwifery caseload care. Specifically, communication, inter-disciplinary collegial relationships, and managerial support are crucial to the sustainability and ultimate upscaling of caseload midwifery care. ConclusionSystem change is challenging, but in order to improve access to midwifery CoC is necessary.

The impact of caseload midwifery, compared with standard care, on women's perceptions of antenatal care quality: Survey results from the M@NGO randomized controlled trial for women of any risk

The measurement and interpretation of patient experience is a distinct dimension of health care quality. The Midwives @ New Group practice Options (M@NGO) randomized control trial of caseload midwifery compared with standard care among women regardless of risk reported both clinical and cost benefits. This study reports participants' perceptions of the quality of antenatal care within caseload midwifery, compared with standard care for women of any risk within that trial. A trial conducted at two Australian tertiary hospitals randomly assigned participants (1:1) to caseload midwifery or standard care regardless of risk. Women were sent an 89-question survey at 6 weeks postpartum that included 12 questions relating to pregnancy care. Ten survey questions (including 7-point Likert scales) were analyzed by intention to treat and illustrated by participant quotes from two free-text open-response items. From the 1748 women recruited to the trial, 58% (n=1017) completed the 6-week survey. Of those allocated to caseload midwifery, 66% (n=573) responded, compared with 51% (n=444) of those allocated to standard care. The survey found women allocated to caseload midwifery perceived a higher level of quality care across every antenatal measure. Notably, those women with identified risk factors reported higher levels of emotional support (aOR 2.52 [95% CI 1.87-3.39]), quality care (2.94 [2.28-3.79]), and feeling actively involved in decision-making (3.21 [2.35-4.37]). Results from the study show that in addition to the benefits to clinical care and cost demonstrated in the M@NGO trial, caseload midwifery outperforms standard care in perceived quality of pregnancy care regardless of risk.

Midwifery students’ experiences of working within a midwifery caseload model

BackgroundWork integrated learning opportunities account for approximately half of the Bachelor of Midwifery program with the goal being to ensure that on graduation students are skilled to provide woman centred evidenced based midwifery care within any environment. There is increasing concern, however, over the quality of clinical experiences students are afforded. ObjectiveThis study explored the experiences of third year Bachelor of Midwifery students in South East Queensland undertaking a clinical placement within a midwifery caseload model. DesignA qualitative descriptive approach was adopted. Data were collected using semi-structured, digitally recorded telephone interviews. Thematic analysis was used to analyse the data set. SettingMidwifery student clinical placement in caseload practice ParticipantsTwelve third year Bachelor of Midwifery students from one university who had experienced a clinical placement in a caseload midwifery model of between 4 and 8 weeks. FindingsFive themes emerged. These were labelled ‘stepping in her shoes’, ‘bringing it all together’, ‘my own captive educator’, ‘knowing the woman’, and ‘it was hard – but it was worth it’. The three-way relationship between midwife, woman and student facilitated deep and active learning leading to a growth in confidence and readiness for practice. Students were afforded the opportunity to constantly integrate theory into practice within a woman centred social model of care where they also grew to understand how midwives operationalise caseload practice in a sustainable way. Students acknowledged the challenges they faced undertaking the placement, but all confirmed the value it had afforded them. Key conclusions and implications for practiceThis study has provided evidence that situating midwifery students within a continuity of care model facilitated a rich holistic learning experience for students. Not only did the placement enhance student's confidence and competence it also provided a real-world view of what working in that a caseload model could be like on graduation. This is vital if the profession is to support system level change ensuring all women have access to evidence informed maternity care.

The midwifery-led care model: a continuity of care model in the birth path.

Background and aim of the study:The birth path is affected by a fragmentation in the patient care process, creating a discontinuity of this last one. The pregnant woman has to interface with many professionals, both during the pregnancy, the childbirth and the puerperium. However, during the last ten years, there has been an increasing of the pregnancy care operated by the midwife, who is considered to be the operator with the right competences, who can take care of every pregnancy and may avail herself of other professionals’ contributions in order to improve the outcomes of maternal and neonatal health.Aim:To verify whether there are proofs of effectiveness that support the caseload midwifery care model, and if it is possible to apply this model in the birth path in Italy.Methods:A revision of literature has been done using some search engine (Google, Bing) and specific databases (MEDLINE, CINAHL, Embase, Home - ClinicalTrials.gov). There has also been a consultation of the Italian regulations, the national guidelines and the recommendations of WHO.Results:The search string, properly adapted to the three databases, has given the following results: MEDLINE 64 articles, CINAHL 94 articles, Embase 88 articles. From this selection, 14 articles have been extracted: 1 systematic review, 3 controlled random trial, 7 observational studies, 3 qualitative studies.Conclusions:The caseload midwifery care seems to be an effective and reliable organisational/caring method. It responds to the criterions of quality and security, to the needs of women not only during the pregnancy but also during the post-partum phase. For these reasons, it seems very useful also for the birth path in the Italian reality. (www.actabiomedica.it)

Labour outcomes in caseload midwifery and standard care: a register-based cohort study

BackgroundResearch on caseload midwifery in a Danish setting is missing. This cohort study aimed to compare labour outcomes in caseload midwifery and standard midwifery care.MethodsA historical register-based cohort study was carried out using routinely collected data about all singleton births 2013–2016 in two maternity units in the North Denmark Region. In this region, women are geographically allocated to caseload midwifery or standard care, as caseload midwifery is only available in some towns in the peripheral part of the uptake areas of the maternity units, and it is the only model of care offered here. Labour outcomes of 2679 all-risk women in caseload midwifery were compared with those of 10,436 all-risk women in standard midwifery care using multivariate linear and logistic regression analyses.ResultsCompared to women in standard care, augmentation was more frequent in caseload women (adjusted odds ratio (aOR) 1.20; 95% CI 1.06–1.35) as was labour duration of less than 10 h (aOR 1.26; 95% CI 1.13–1.42). More emergency caesarean sections were observed in caseload women (aOR 1.17; 95% CI 1.03–1.34), but this might partly be explained by longer distance to the maternity unit in caseload women. When caseload women were compared to women in standard care with a similar long distance to the hospital, no difference in emergency caesarean sections was observed (aOR 1.04; 95% CI 0.84–1.28).Compared to standard care, infants of caseload women more often had Apgar ≤7 after 5 min. (aOR 1.57; 95% CI 1.11–2.23) and this difference remained when caseload women were compared to women with similar distance to the hospital.For elective caesarean sections, preterm birth, induction of labour, dilatation of cervix on admission, amniotomy, epidural analgesia, and instrumental deliveries, we did not obseve any differences between the two groups. After birth, caseload women more often experienced no laceration (aOR 1.17; 95% CI 1.06–1.29).ConclusionsFor most labour outcomes, there were no differences across the two models of midwifery-led care but unexpectedly, we observed slightly more augmentation and adverse neonatal outcomes in caseload midwifery. These findings should be interpreted in the context of the overall low intervention and complication rates in this Danish setting and in the context of research that supports the benefits of caseload midwifery. Although the observational design of the study allows only cautious conclusions, this study highlights the importance of monitoring and evaluating new practices contextually.

Comparison of the effect of caseload midwifery program and standard midwifery-led care on primiparous birth outcomes: A retrospective cohort matching study

BackgroundThe effectiveness of continuity of care during the perinatal period is well documented, but implementing continuity of care model to practice requires evaluation. AimTo evaluate the effect of a caseload midwifery program (CMP) on birth outcomes and rates of perinatal interventions at a metropolitan tertiary hospital in Australia, compared with standard midwifery-led care (SMC). MethodsThis was a retrospective, matched-cohort study. We extracted the data of 1000 nulliparous women from records of 19,001 women who gave birth at the hospital from 2011 to 2014. We used basic statistical tests to compare baseline demographic data, and logistic regression to calculate odds ratios, to evaluate maternal and neonatal outcomes. ResultsAdjusted regression analysis for the primary outcome showed that compared with women who received SMC, women who received care through CMP had an increased rate of normal vaginal birth (69% vs. 50%, OR = 1.79, 95%, CI = 1.38–2.32). Assessment of secondary outcomes showed that the women in CMP group had decreased rates of instrumental birth (15% vs. 26%, OR = 0.48, 95% CI = 0.35–0.66), episiotomy (23% vs. 40%, OR = 0.43, 95% CI = 0.33–0.57), epidural analgesia (33% vs. 43%, OR = 0.64, 95% CI = 0.50–0.83) and amniotomy (35% vs. 50%, OR = 0.56, 95% CI = 0.43–0.72). The CMP group also had greater rates of water immersion (54% vs. 22%, OR = 4.18, 95% CI = 3.17–5.5), physiological 3rd stage (7% vs. 1%, OR = 11.71, 95% CI = 3.56–38.43) and 2nd degree tear (34% vs. 24%, OR = 1.60, 95% CI = 1.21–2.11). There were no significant differences between the two groups for rates of other secondary outcomes including Caesarean section, cervical ripening procedures, third- and fourth-degree tears, postpartum haemorrhage and neonatal outcomes. ConclusionCMP care is associated with increased rate of normal vaginal birth which supports wider implementation of the model. In addition, using routinely collected data and a cohort matching design can be an effective approach to evaluate maternal and neonatal outcomes.

A survey of burnout and intentions to leave the profession among Western Canadian midwives

ProblemMidwives are at high risk for burnout and occupational stress. This has implications for workforce retention and quality of maternity care. AimWe set out to understand how burnout and occupational stress are experienced by midwives in Western Canada, and whether burnout is linked to intentions to leave the profession and other factors. MethodsMidwives were invited to participate in the international WHELM (work, health, and emotional lives of midwives) survey through invitations via their professional organizations. The survey included demographic questions and emotional wellbeing scales such as the Copenhagen Burnout Inventory and the Depression, Anxiety, and Stress Scale. ResultsOf 158 midwives who participated, 51 (34.7%) had seriously considered leaving the profession, citing reasons such as the negative impact of an on-call schedule on personal life (n=84, 84.8%), as well as concerns about their mental (n=80, 80.8%) and physical health (n=57, 57.6%). Burnout scores were higher among midwives who planned to leave the profession, midwives with young children, those with higher caseloads and fewer days off. Quality of life was significantly lower among midwives who reported higher burnout scores. Midwives suggested many strategies to reduce stress, such as part-time work options, support for sick days/vacation coverage, more pay per course of care, more off-call career opportunities and initiatives to reduce bullying and interprofessional conflict. Discussion/ConclusionThe current study identified occupational stressors that are unique to the caseload model. Findings from this study can inform policies and strategies to support the growth and sustainability of caseload midwifery in Canada.

Can continuity bring birth back to women and normality back to midwives?

Continuity of midwifery care, and caseload care in particular, is associated with a vast and varied array of improved outcomes for mothers and their families, including reduced intervention, reduced need for analgesia in labour, reduced preterm birth, and improved satisfaction with the birth experience. Caseload models of care may also increase midwives' satisfaction with their role and, contrary to what is often thought, may result in an improved work-life balance, and reduced burnout when compared to models of standard care. This article discusses how caseload midwifery might result in both women and midwives becoming more empowered and autonomous, and may facilitate a redirection of midwifery philosophy back to promoting and protecting normal birth.