Continuity of care by a midwife team versus routine care during pregnancy and birth: a randomised trial

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Abstract
Objective To compare continuity of care from a midwife team with routine care from a variety of doctors and midwives. Design A stratified, randomised controlled trial. Participants and setting 814 women attending the antenatal clinic of a tertiary referral, university hospital. Intervention Women were randomly allocated to team care from a team of six midwives, or routine care from a variety of doctors and midwives. Main outcome measures Antenatal, intrapartum and neonatal events; maternal satisfaction; and cost of treatment. Results 405 women were randomly allocated to team care and 409 to routine care; they delivered 385 and 386 babies, respectively. Team care women were more likely to attend antenatal classes (OR, 1.73; 95% Cl, 1.23‐2.42); less likely to use pethidine during labour (OR, 0.32; 95% Cl, 0.22‐0.46); and more likely to labour and deliver without intervention (OR, 1.73; 95% Cl, 1.28‐2.34). Babies of team care mothers received less neonatal resuscitation (OR, 0.59; 95% Cl, 0.41‐0.86), although there was no difference in Apgar scores at five minutes (OR, 0.86; 95% Cl, 0.29‐2.57). The stillbirth and neonatal death rate was the same for both groups of mothers with a singleton pregnancy (three deaths), but there were three deaths (birthweights of 600 g, 660 g, 1340 g) in twin pregnancies in the group receiving team care. Team care was rated better than routine care for all measures of maternal satisfaction. Team care meant a cost reduction of 4.5%. Conclusion Continuity of care provided by a small team of midwives resulted in a more satisfying birth experience at less cost than routine care and fewer adverse maternal and neonatal outcomes. Although a much larger study would be required to provide adequate power to detect rare outcomes, our study found that continuity of care by a midwife team was as safe as routine care.