standard maternity care
'one-to-one' midwifery support
In July 2012, findings from the COSMOS trial were published in the British Journal of Obstetrics and Gynaecology. In October 2015, the International Journal of Obstetrics and Gynaecology (BJOG) published the results (see press release).
COSMOS — 'COmparing Standard Maternity care with One to one midwifery Support' — was a trial of caseload midwifery, a model of maternity care recommended in Victoria and throughout Australia.
A number of hospitals have introduced caseload in recent years; however, the model had not been subjected to rigorous evaluation.
Funded by the National Health and Medical Research Council, the trial compared caseload midwifery care with standard options of care for women at low risk of medical complications at the Royal Women's Hospital in Melbourne. In caseload midwifery, women are cared for by a primary midwife throughout pregnancy, birth and the early postnatal period, and care is provided by one or two back-up midwives when needed.
The study is the first randomised controlled trial of caseload midwifery in Australia and only the third internationally. It is also the largest study of its kind in the world.
The COSMOS trial, which recruited over 2,300 women, found that women who were randomly allocated to receive caseload midwifery care (compared with women allocated to standard care)
- were less likely to have a caesarean birth,
- more likely to have a normal birth, and
- less likely to have epidural pain relief during labour.
- The study also found that babies of women who had caseload midwifery care were less likely to be admitted to the special care nursery or neonatal intensive care.
- Women allocated to caseload midwifery were also more satisfied with their care during pregnancy, birth, and after the birth in hospital and at home.
The reduction in caesarean births and associated reduction in length of stay may also yield some cost savings. A full cost analysis and cost-effectiveness analysis will be completed based on these birth outcomes and data on service use and costs over the first six months after birth.
The results will assist policy-makers and maternity services in planning for future models of maternity care in Australia and internationally.
McLachlan HL, Forster DA, Davey MA, Lumley J, Farrell T, Oats J, Gold L, Waldenstrom U, Albers L, Biro MA. COSMOS: COmparing Standard Maternity care with one-to-one midwifery support: A randomised controlled trial. BMC Pregnancy Childbirth 2008; 8: 35. View this article online
Publication of results
McLachlan HL, Forster DA, Davey MA, Farrell T, Gold L, Biro MA, Albers L, Flood M, Oats J, Waldenström U. Effects of continuity of care by a primary midwife (caseload midwifery) on caesarean section rates in women of low obstetric risk: the COSMOS randomised controlled trial. BJOG 2012;119(12):1483–92. View this article online
Davey M-A, McLachlan H, Forster D, Flood M. Influence of timing of admission in labour and management of labour on method of birth: results from a randomised controlled trial of caseload midwifery (COSMOS trial). Midwifery 2013;29(12):1297–302. View this article online
McLachlan HL, Forster DA, Davey MA, Farrell T, Flood M, Shafiei T, Waldenström U. The effect of primary midwife-led care on women's experience of childbirth: results from the COSMOS randomised controlled trial. BJOG 2015 (in press). Epub 2015 Oct 26. View this article online
Related news articles
There has been a lot of media coverage since the findings were published on 25 July 2012. Here are some of the headlines:
- Dedicated midwives a boon to births: study. The Age, July 26, 2012
- One-on-one midwife care decreases chance of caesarean, study finds. MIDWIFE care could be the key to cutting the rising rate of caesarean sections. Herald Sun, July 26, 2012
- Benefits in same midwife during pregnancy. The Australian, July 26, 2012
- Midwives beat standard care: research. Canberra Times, July 26, 2012
- Dedicated midwives a boon to births: study. WA Today, July 26, 2012
- Benefits in same midwife during pregnancy. Perth Now, July 26, 2012
- Benefits in same midwife during pregnancy. 9News, July 26, 2012
- Same midwife can lead to easier birth. Sky News, July 26, 2012
- One-to-one midwifery improves care. La Trobe University News, July 26, 2012
- Continuity of midwifery care reduces caesarean section rates during childbirth and leads to better health outcomes for babies. Australian Healthcare and Hospitals Association, July 26, 2012
- An interview with Helen McLachlan could also be heard on 3A news on July 26.
- The Wire aired an interview titled Midwives crucial in reducing caesareans on July 27.
- Dr Norman Swan's interview with Helen McLachlan for Radio National's Health Report was broadcast on August 6.
For more information about the trial, please contact Professor Helen McLachlan on
(03) 9479 8800 or email email@example.com.