The effect of primary midwife-led care on women's experience of childbirth: results from the COSMOS randomised controlled trial

ObjectiveTo determine the effect of primary midwife-led care (caseload midwifery') on women's experiences of childbirth. DesignRandomised controlled trial. SettingTertiary care women's hospital in Melbourne, Australia. PopulationA total of 2314 low-risk pregnant women. MethodsWomen randomised to caseload care received antenatal, intrapartum and postpartum care from a primary midwife, with some care provided by a back-up' midwife. Women in standard care received midwifery-led care with varying levels of continuity, junior obstetric care or community-based medical care. Main outcome measuresThe primary outcome of the study was caesarean section. This paper presents a secondary outcome, women's experience of childbirth. Women's views and experiences were sought using seven-point rating scales via postal questionnaires 2 months after the birth. ResultsA total of 2314 women were randomised between September 2007 and June 2010; 1156 to caseload and 1158 to standard care. Response rates to the follow-up questionnaire were 88 and 74%, respectively. Women in the caseload group were more positive about their overall birth experience than women in the standard care group (adjusted odds ratio 1.50, 95% CI 1.22-1.84). They also felt more in control during labour, were more proud of themselves, less anxious, and more likely to have a positive experience of pain. ConclusionsCompared with standard maternity care, caseload midwifery may improve women's experiences of childbirth. Tweetable abstractPrimary midwife-led care (caseload midwifery') improves women's experiences of childbirth. Tweetable abstract Primary midwife-led care (caseload midwifery') improves women's experiences of childbirth.