COSMOS: COmparing Standard Maternity care with one-to-one midwifery support: a randomised controlled trial
Helen L McLachlan1, Della A Forster, Mary-Ann Davey
1Mother and Child Health Research, La Trobe University, 324-328 Little Lonsdale St, Melbourne, Australia. h.mclachlan@latrobe.edu.au
BMC Pregnancy and Childbirth
|August 6, 2008
Summary
Caseload midwifery care, providing one-to-one support, aims to reduce caesarean sections in low-risk women. This study protocol details a trial comparing caseload midwifery to standard care to assess its impact on birth interventions.
Area of Science:
- Obstetrics and Gynecology
- Maternal Health
- Midwifery Care Models
Background:
- Rising caesarean section rates internationally pose risks like placenta accreta and impact fertility.
- Previous trials on continuity of midwifery care often involved large teams, not one-to-one caseload models.
- This study addresses the need to evaluate the effectiveness of caseload midwifery for low-risk pregnancies.
Purpose of the Study:
- To determine if one-to-one caseload midwifery care decreases caesarean section rates in low-risk women compared to standard care.
- To present the detailed trial protocol for this comparison.
Main Methods:
- A two-arm randomised controlled trial (RCT) involving 2008 low-risk women in Melbourne, Australia.
- Intervention group receives caseload midwifery (one primary midwife with backup); control group receives standard low-risk care.
- Data collection includes surveys at recruitment and postpartum, with medical record abstraction for outcomes.
Main Results:
- The study is designed to detect a decrease in caesarean birth rate from 19% to 14%.
- Aims to identify other significant clinical differences between the care models.
- Comprehensive process and economic evaluations will be conducted.
Conclusions:
- The findings will inform the optimal model of midwifery care for reducing caesarean births.
- Evidence generated will guide policy and practice regarding caseload midwifery.
- This trial protocol provides a robust framework for evaluating caseload midwifery's impact on birth outcomes.
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