Can birth outcome inequality be reduced using targeted caseload midwifery in a deprived diverse inner city population? A retrospective cohort study, London, UK.

Hadebe, R; Seed, PT; Essien, D; Headen, K; Mahmud, S; Owasil, S; Fernandez Turienzo, C; Stanke, C; Sandall, J; Bruno, M; Khazaezadeh, N; Oteng-Ntim, E

Can birth outcome inequality be reduced using targeted caseload midwifery in a deprived diverse inner city population? A retrospective cohort study, London, UK.

Hadebe, R Seed, PT Essien, D Headen, K Mahmud, S Owasil, S Fernandez Turienzo, C Stanke, C Sandall, J

Bruno, M Khazaezadeh, N Oteng-Ntim, E

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Publisher:: BMJ
Publication Type:: Journal Article
Citation:: BMJ open, 2021, 11, (11), pp. e049991
Issue Date:: 2021-11

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Field	Value	Language
dc.contributor.author	Hadebe, R
dc.contributor.author	Seed, PT
dc.contributor.author	Essien, D
dc.contributor.author	Headen, K
dc.contributor.author	Mahmud, S
dc.contributor.author	Owasil, S
dc.contributor.author	Fernandez Turienzo, C
dc.contributor.author	Stanke, C
dc.contributor.author	Sandall, J https://orcid.org/0000-0003-2000-743X
dc.contributor.author	Bruno, M
dc.contributor.author	Khazaezadeh, N
dc.contributor.author	Oteng-Ntim, E
dc.date.accessioned	2021-12-29T00:19:13Z
dc.date.available	2021-12-29T00:19:13Z
dc.date.issued	2021-11
dc.identifier.citation	BMJ open, 2021, 11, (11), pp. e049991
dc.identifier.issn	2044-6055
dc.identifier.issn	2044-6055
dc.identifier.uri	http://hdl.handle.net/10453/152557
dc.description.abstract	<h4>Objectives</h4>(1) To report maternal and newborn outcomes of pregnant women in areas of social deprivation in inner city London. (2) To compare the effect of caseload midwifery with standard care on maternal and newborn outcomes in this cohort of women.<h4>Design</h4>Retrospective observational cohort study.<h4>Setting</h4>Four council wards (electoral districts) in inner city London, where over 90% of residents are in the two most deprived quintiles of the English Index of Multiple Deprivation (IMD) (2019) and the population is ethnically diverse.<h4>Participants</h4>All women booked for antenatal care under Guys and St Thomas' National Health Service Foundation Trust after 11 July 2018 (when the Lambeth Early Action Partnership (LEAP*) caseload midwifery team was implemented) until data collection 18 June 2020. This included 523 pregnancies in the LEAP area, of which 230 were allocated to caseload midwifery, and 8430 pregnancies from other areas.<h4>Main outcome measures</h4>To explore if targeted caseload midwifery (known to reduce preterm birth) will improve important measurable outcomes (preterm birth, mode of birth and newborn outcomes).<h4>Results</h4>There was a significant reduction in preterm birth rate in women allocated to caseload midwifery, when compared with those who received traditional midwifery care (5.1% vs 11.2%; risk ratio: 0.41; p=0.02; 95% CI 0.18 to 0.86; number needed to treat: 11.9). Caesarean section births were significantly reduced in women allocated to caseload midwifery care, when compared with traditional midwifery care (24.3% vs 38.0%; risk ratio: 0.64: p=0.01; 95% CI 0.47 to 0.90; number needed to treat: 7.4) including emergency caesarean deliveries (15.2% vs 22.5%; risk ratio: 0.59; p=0.03; 95% CI 0.38 to 0.94; number needed to treat: 10) without increase in neonatal unit admission or stillbirth.<h4>Conclusion</h4>This study shows that a model of caseload midwifery care implemented in an inner city deprived community improves outcome by significantly reducing preterm birth and birth by caesarean section when compared with traditional care. This data trend suggests that when applied to targeted groups (women in higher IMD quintile and women of diverse ethnicity) that the impact of intervention is greater.
dc.format	Electronic
dc.language	eng
dc.publisher	BMJ
dc.relation.ispartof	BMJ open
dc.relation.isbasedon	10.1136/bmjopen-2021-049991
dc.rights	info:eu-repo/semantics/openAccess
dc.subject	1103 Clinical Sciences, 1117 Public Health and Health Services, 1199 Other Medical and Health Sciences
dc.subject.mesh	Cesarean Section
dc.subject.mesh	Cohort Studies
dc.subject.mesh	Female
dc.subject.mesh	Humans
dc.subject.mesh	Infant, Newborn
dc.subject.mesh	London
dc.subject.mesh	Midwifery
dc.subject.mesh	Pregnancy
dc.subject.mesh	Premature Birth
dc.subject.mesh	Retrospective Studies
dc.subject.mesh	Social Deprivation
dc.subject.mesh	State Medicine
dc.title	Can birth outcome inequality be reduced using targeted caseload midwifery in a deprived diverse inner city population? A retrospective cohort study, London, UK.
dc.type	Journal Article
utslib.citation.volume	11
utslib.location.activity	England
utslib.for	1103 Clinical Sciences
utslib.for	1117 Public Health and Health Services
utslib.for	1199 Other Medical and Health Sciences
pubs.organisational-group	/University of Technology Sydney
pubs.organisational-group	/University of Technology Sydney/Faculty of Health
pubs.organisational-group	/University of Technology Sydney/Faculty of Health/Midwifery
utslib.copyright.status	open_access	*
dc.date.updated	2021-12-29T00:19:10Z
pubs.issue	11
pubs.publication-status	Published
pubs.volume	11
utslib.citation.issue	11

Abstract:

Objectives

(1) To report maternal and newborn outcomes of pregnant women in areas of social deprivation in inner city London. (2) To compare the effect of caseload midwifery with standard care on maternal and newborn outcomes in this cohort of women.

Design

Retrospective observational cohort study.

Setting

Four council wards (electoral districts) in inner city London, where over 90% of residents are in the two most deprived quintiles of the English Index of Multiple Deprivation (IMD) (2019) and the population is ethnically diverse.

Participants

All women booked for antenatal care under Guys and St Thomas' National Health Service Foundation Trust after 11 July 2018 (when the Lambeth Early Action Partnership (LEAP*) caseload midwifery team was implemented) until data collection 18 June 2020. This included 523 pregnancies in the LEAP area, of which 230 were allocated to caseload midwifery, and 8430 pregnancies from other areas.

Main outcome measures

To explore if targeted caseload midwifery (known to reduce preterm birth) will improve important measurable outcomes (preterm birth, mode of birth and newborn outcomes).

Results

There was a significant reduction in preterm birth rate in women allocated to caseload midwifery, when compared with those who received traditional midwifery care (5.1% vs 11.2%; risk ratio: 0.41; p=0.02; 95% CI 0.18 to 0.86; number needed to treat: 11.9). Caesarean section births were significantly reduced in women allocated to caseload midwifery care, when compared with traditional midwifery care (24.3% vs 38.0%; risk ratio: 0.64: p=0.01; 95% CI 0.47 to 0.90; number needed to treat: 7.4) including emergency caesarean deliveries (15.2% vs 22.5%; risk ratio: 0.59; p=0.03; 95% CI 0.38 to 0.94; number needed to treat: 10) without increase in neonatal unit admission or stillbirth.

Conclusion

This study shows that a model of caseload midwifery care implemented in an inner city deprived community improves outcome by significantly reducing preterm birth and birth by caesarean section when compared with traditional care. This data trend suggests that when applied to targeted groups (women in higher IMD quintile and women of diverse ethnicity) that the impact of intervention is greater.

Please use this identifier to cite or link to this item:

http://hdl.handle.net/10453/152557