Please use this identifier to cite or link to this item: https://doi.org/10.1016/j.midw.2017.07.010
Title: Comparison of midwife-led care and obstetrician-led care on maternal and neonatal outcomes in Singapore: A retrospective cohort study
Authors: Voon, Shi Tian
Lay, Julie Tay Suan 
San, Wilson Tam Wai 
Shorey, Shefaly 
Lin, Serena Koh Siew 
Keywords: Science & Technology
Life Sciences & Biomedicine
Nursing
Midwife-led care
Midwifery
Obstetrician-led care
Maternal outcomes
Neonatal outcomes
LOW-RISK WOMEN
CASELOAD MIDWIFERY
ANTENATAL CARE
BIRTH
EPISIOTOMY
MORBIDITY
DELIVERY
RATES
Issue Date: 1-Oct-2017
Publisher: ELSEVIER SCI LTD
Citation: Voon, Shi Tian, Lay, Julie Tay Suan, San, Wilson Tam Wai, Shorey, Shefaly, Lin, Serena Koh Siew (2017-10-01). Comparison of midwife-led care and obstetrician-led care on maternal and neonatal outcomes in Singapore: A retrospective cohort study. MIDWIFERY 53 : 71-79. ScholarBank@NUS Repository. https://doi.org/10.1016/j.midw.2017.07.010
Abstract: Objectives to examine the maternal and neonatal outcomes of low-risk women receiving midwife-led care and obstetrician-led care. Design, setting,&participants a retrospective cohort study design was used. Data were collected from a large tertiary maternity hospital in Singapore. This involved a medical record review of 368 women who had singleton, normal to low-risk, term pregnancy, and received midwife-led care and obstetrician-led care between 2013 to 2014. Measurements a data extraction tool was used to solicit information on the outcome measures, including duration of labour, mode of delivery, episiotomy, and 5-minutes Apgar score (<7). Descriptive statistics were used to summarise the women's ‘characteristics. χ2 and independent sample t-test were used to assess the differences in demographics and birth outcomes. Multiple linear and logistic regressions were used to examine the difference between the two comparison groups after adjusted for potential confounders. Findings statistically significant differences (p<0.05) between the midwife-led care group and the obstetrician-led care group in terms of the total duration of labour and total antenatal visits were found. No statistically significant differences were observed for mode of delivery, episiotomy, intrapartum pain management, labour augmentation, labour induction, postpartum haemorrhage, perineal trauma, birth status, 5-minutes Apgar score (<7), low birth weight (<2500 g), and neonatal admission to intensive care units between the midwife-led care group and the obstetrician-led care group. Key conclusions while interventions such as episiotomies and labour augmentation were more common in the midwife-led care group, no significant differences were found for most of the outcome measures between the two maternity groups except for total antenatal visits and duration of labour. Findings suggest that midwife-led care is as safe and effective as obstetrician-led care in achieving optimal birth outcomes, with no higher risk of adversities for low-risk women. Additional studies are necessary to continuously evaluate midwife-led care and to promote normal birth and reduce excessive use of obstetric procedures. Implications for practice the provision of midwife-led care should continue to be extended as an additional choice in maternity care for women with low-risk pregnancies. Professional staff development with continuous education is needed to clear misconceptions about midwife-led care and to promote awareness in current practice guidelines. Prospective evaluation of midwife-led care will be beneficial in informing policies and practise guidelines.
Source Title: MIDWIFERY
URI: https://scholarbank.nus.edu.sg/handle/10635/226899
ISSN: 0266-6138
1532-3099
DOI: 10.1016/j.midw.2017.07.010
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