One-to-one midwifery improves care

BabyThe Royal Women’s Hospital (the Women’s), and La Trobe University have conducted the world’s largest clinical trial of one-to-one (caseload) midwifery care. 

The COSMOS trial (COmparing Standard Maternity care with One-to-One Midwifery Support) found women who receive this type of care were more likely to have a normal birth without medical intervention.  These women were also less likely to need epidural pain relief during labour when compared with standard maternity care.

More importantly, their babies were less likely to be admitted to special care or neonatal intensive care.

The study, published today in the British Journal of Obstetrics and Gynaecology also found women were more satisfied with the caseload care they received during pregnancy, birth, and after birth in hospital and at home.

The caseload model involved women being looked after by a primary midwife throughout pregnancy, birth and in the early postnatal period. Some 2,300 women at low risk of medical complications during pregnancy took part in the trial at the Women's.

Lead author of the study, Associate Professor Helen McLachlan from Mother and Child Health Research at La Trobe University, said midwives and women had the opportunity to establish a relationship during pregnancy with the caseload model of care.

“This relationship appears to build a woman’s trust and confidence before, during and after the birth, helping women have a more positive birth experience,” Associate Professor McLachlan said. 

According to Professor Della Forster, a co-author and Professor of Midwifery at the Women’s, a reduction of caesarean rates in low-risk pregnancies was a welcome outcome of the trial.

“We want to avoid caesarean births wherever possible because of the risk of complications for both mothers and babies,” Professor Forster said.

The study is the first trial of caseload midwifery in Australia and only the third internationally. The results will assist policy makers and maternity services in planning for future models of maternity care in Australia and internationally. 

The study was funded by a $600,000 National Health and Medical Research Council grant.

To obtain a full copy of the report contact Mikhaela Delahunty, Media and Communications Officer, La Trobe University on 03 9479 5517 or email