Since 1990, caesareans have more than tripled from 6 percent of all births to 21 percent. According to three studies in The Lancet, caesareans now outnumber vaginal births in some parts of southeast Europe, Latin America and China.
“Caesareans can be life-saving,” explains Professor Helen McLachlan, “but this is a medical intervention that should only be used when medically indicated”
McLachlan leads a team of researchers from La Trobe University and The Royal Women’s Hospital in Melbourne who have developed a gold standard in maternity care that may reduce the number of caesareans.
The research project, COmparing Standard Midwifery care with One-to-one midwifery Support (COSMOS), was established in 2007. Since then, it has become the world’s largest randomised trial of caseload midwifery; an approach that assigns one midwife, or a small team of midwives, to a pregnant woman for the duration of the perinatal period.
“The COSMOS trial has confirmed the importance of caseload midwifery,” says McLachlan. “This approach encourages relationship building, resulting in improved clinical and psychosocial outcomes for mothers, fewer caesareans, and greater job satisfaction for midwives.”
Further research is now underway. A collaboration between four Australian health services, the Victorian Aboriginal Community Controlled Health Organisation and La Trobe University is working to improve maternity outcomes for Aboriginal and Torres Strait Islander people.
The program, called Baggarook Yarrongi (“Women’s Journey” in the Woiwurrung language), won a Victorian Healthcare Award for Improving Aboriginal Health in 2019.
“The COSMOS approach creates a positive maternity experience for mothers, babies and midwives,” adds McLachlan, “one that is transformative, sustainable, and produces real results.”