Bulletin

Issue: March/April 2007

Research in Action

First trial of caseload midwifery

Dr Helen McLachlan, a senior lecturer in La Trobe’s School of Nursing and Midwifery, and a team from the University’s Mother and Child Health Research Centre, the Royal Women’s Hospital and the Karolinska Institute in Sweden, have received a grant of $583,000 from the National Health and Medical Research Council to conduct the first randomised trial of caseload midwifery in Australia.

The trial’s main aim is to evaluate whether caseload midwifery decreases the number of caesarean births compared with ‘standard’ care. The number of instrumental vaginal births, perineal trauma, and induction of labour will also be examined. It will also compare postnatal depression, maternal satisfaction with care, and duration of breastfeeding, as well as costs, and the health outcomes for mothers and babies.

Dr McLachlan says it is the first trial of its kind in Australia, and only the third in the world. Called COSMOS - COmparing Standard Maternity care with One-onone midwifery Support - it will recruit 2,000 women from three hospitals. They are the Royal Women’s Hospital, Monash Medical Centre, and Casey Hospital.

Dr McLachlan explains that in the caseload midwifery model of maternity care, women are looked after by a primary midwife throughout pregnancy, birth and the early postnatal period to ensure continuity of carer for both women and midwives.

‘Midwives and women have the opportunity to establish a relationship during pregnancy. The primary midwife is on call for labour and works with one or two other midwives who meet the woman and do an antenatal check during pregnancy. ‘In this way there is back up if needed, for example if the primary midwife is on leave when labour begins.’

A fulltime midwife usually cares for more than forty women a year.

‘However,’ says Dr McLachlan, ‘the model has been subjected to little rigorous evaluation in Australia or internationally, and if a new type of care is to be introduced, it is important that we evaluate the outcomes for mothers and babies as well as the sustainability of the midwifery workforce.’

Half the women in the study will be randomly allocated to receive the caseload model of care during their pregnancy, with the remainder on standard care.

‘It is important to evaluate the model in this way as we do not know at the moment which type of care is better,’ Dr McLachlan says. ‘It should take two years to recruit women for the trial, and three years for the results to be available.

Other members of the team are Dr Della Forster, Ms Mary- Ann Davey, Ms Lisa Gold and Professor Judith Lumley from the La Trobe Mother and Child Health Research Centre; Ms Tanya Farrell and Dr Jeremy Oats from the Royal Women’s Hospital; and Professor Ulla Waldenström from the Karolinska Institute.