Collaboration in maternity care: A randomised controlled trial comparing community-based continuity of care with standard hospital care

Homer, CSE; Davis, GK; Brodie, PM; Sheehan, A; Barclay, LM; Wills, J; Chapman, MG

Collaboration in maternity care: A randomised controlled trial comparing community-based continuity of care with standard hospital care

Homer, CSE

Davis, GK Brodie, PM Sheehan, A

Barclay, LM

Wills, J Chapman, MG

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Publication Type:: Journal Article
Citation:: British Journal of Obstetrics and Gynaecology, 2001, 108 (1), pp. 16 - 22
Issue Date:: 2001-02-07

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Field	Value	Language
dc.contributor.author	Homer, CSE https://orcid.org/0000-0002-7454-3011	en_US
dc.contributor.author	Davis, GK	en_US
dc.contributor.author	Brodie, PM	en_US
dc.contributor.author	Sheehan, A https://orcid.org/0000-0002-2035-504X	en_US
dc.contributor.author	Barclay, LM https://orcid.org/0000-0002-9345-3468	en_US
dc.contributor.author	Wills, J	en_US
dc.contributor.author	Chapman, MG	en_US
dc.date.issued	2001-02-07	en_US
dc.identifier.citation	British Journal of Obstetrics and Gynaecology, 2001, 108 (1), pp. 16 - 22	en_US
dc.identifier.issn	0306-5456	en_US
dc.identifier.uri	http://hdl.handle.net/10453/4593
dc.description.abstract	Objective: To test whether a new community-based model of continuity of care provided by midwives and obstetricians improved maternal clinical outcomes, in particular a reduced caesarean section rate. Design: Randomised controlled trial. Setting: A public teaching hospital in metropolitan Sydney, Australia. Sample: 1089 women randomised to either the community-based model (n = 550) or standard hospital-based care (n = 539) prior to their first antenatal booking visit at an Australian metropolitan public hospital. Main outcome measures: Data were collected on onset and outcomes of labour, antenatal, intrapartum and postnatal complications, antenatal admissions to hospital and neonatal mortality and morbidity. Results: There was a significant difference in the caesarean section rate between the groups, 13.3% (73/550) in the community-based group and 17.8% in the control group (96/539). This difference was maintained after controlling for known contributing factors to caesarean section (OR = 0.6, 95% CI 0.4-0.9, P = 0.02). There were no other significant differences in the events during labour and birth. Eighty babies (14.5%) from the community-based group and 102 (18.9%) from the control group were admitted to the special care nursery, but this difference was not significant (OR 0.75, 95% CI 0.5-1.1, P = 0.12). Eight infants died during the perinatal period (four from each group), for an overall perinatal mortality rate of 7.3 per 1000 births. Conclusion: Community-based continuity of maternity care provided by midwives and obstetricians resulted in a significantly reduced caesarean section rate. There were no other differences in clinical outcomes.	en_US
dc.relation.ispartof	British Journal of Obstetrics and Gynaecology	en_US
dc.relation.isbasedon	10.1016/S0306-5456(00)00022-X	en_US
dc.subject.classification	Obstetrics & Reproductive Medicine	en_US
dc.subject.mesh	Humans	en_US
dc.subject.mesh	Pregnancy Outcome	en_US
dc.subject.mesh	Cesarean Section	en_US
dc.subject.mesh	Infant Mortality	en_US
dc.subject.mesh	Regression Analysis	en_US
dc.subject.mesh	Interprofessional Relations	en_US
dc.subject.mesh	Pregnancy	en_US
dc.subject.mesh	Adult	en_US
dc.subject.mesh	Infant, Newborn	en_US
dc.subject.mesh	Hospitals, Teaching	en_US
dc.subject.mesh	Hospitals, Public	en_US
dc.subject.mesh	Community Health Services	en_US
dc.subject.mesh	Maternal Health Services	en_US
dc.subject.mesh	Health Services Research	en_US
dc.subject.mesh	Continuity of Patient Care	en_US
dc.subject.mesh	New South Wales	en_US
dc.subject.mesh	Female	en_US
dc.title	Collaboration in maternity care: A randomised controlled trial comparing community-based continuity of care with standard hospital care	en_US
dc.type	Journal Article
utslib.citation.volume	1	en_US
utslib.citation.volume	108	en_US
utslib.for	111717 Primary Health Care	en_US
utslib.for	111006 Midwifery	en_US
pubs.embargo.period	Not known	en_US
pubs.organisational-group	/University of Technology Sydney
pubs.organisational-group	/University of Technology Sydney/Faculty of Health
pubs.organisational-group	/University of Technology Sydney/Strength - CHSP - Health Services and Practice
pubs.organisational-group	/University of Technology Sydney/Strength - WHO CC
utslib.copyright.status	open_access
pubs.issue	1	en_US
pubs.publication-status	Published	en_US
pubs.volume	108	en_US

Abstract:

Objective: To test whether a new community-based model of continuity of care provided by midwives and obstetricians improved maternal clinical outcomes, in particular a reduced caesarean section rate. Design: Randomised controlled trial. Setting: A public teaching hospital in metropolitan Sydney, Australia. Sample: 1089 women randomised to either the community-based model (n = 550) or standard hospital-based care (n = 539) prior to their first antenatal booking visit at an Australian metropolitan public hospital. Main outcome measures: Data were collected on onset and outcomes of labour, antenatal, intrapartum and postnatal complications, antenatal admissions to hospital and neonatal mortality and morbidity. Results: There was a significant difference in the caesarean section rate between the groups, 13.3% (73/550) in the community-based group and 17.8% in the control group (96/539). This difference was maintained after controlling for known contributing factors to caesarean section (OR = 0.6, 95% CI 0.4-0.9, P = 0.02). There were no other significant differences in the events during labour and birth. Eighty babies (14.5%) from the community-based group and 102 (18.9%) from the control group were admitted to the special care nursery, but this difference was not significant (OR 0.75, 95% CI 0.5-1.1, P = 0.12). Eight infants died during the perinatal period (four from each group), for an overall perinatal mortality rate of 7.3 per 1000 births. Conclusion: Community-based continuity of maternity care provided by midwives and obstetricians resulted in a significantly reduced caesarean section rate. There were no other differences in clinical outcomes.

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http://hdl.handle.net/10453/4593