Midwifery continuity of care and vaginal birth after caesarean section: A randomised controlled trial.

Homer, CSE; Davis, DL; Mollart, L; Turkmani, S; Smith, RM; Bullard, M; Leiser, B; Foureur, M

Midwifery continuity of care and vaginal birth after caesarean section: A randomised controlled trial.

Homer, CSE Davis, DL Mollart, L Turkmani, S

Smith, RM Bullard, M Leiser, B Foureur, M

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Publisher:: Elsevier BV
Publication Type:: Journal Article
Citation:: Women and birth : journal of the Australian College of Midwives, 2021
Issue Date:: 2021-06-05

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Field	Value	Language
dc.contributor.author	Homer, CSE
dc.contributor.author	Davis, DL
dc.contributor.author	Mollart, L
dc.contributor.author	Turkmani, S https://orcid.org/0000-0001-7819-5061
dc.contributor.author	Smith, RM
dc.contributor.author	Bullard, M
dc.contributor.author	Leiser, B
dc.contributor.author	Foureur, M
dc.date.accessioned	2022-01-05T04:20:13Z
dc.date.available	2021-05-27
dc.date.available	2022-01-05T04:20:13Z
dc.date.issued	2021-06-05
dc.identifier.citation	Women and birth : journal of the Australian College of Midwives, 2021
dc.identifier.issn	1871-5192
dc.identifier.issn	1878-1799
dc.identifier.uri	http://hdl.handle.net/10453/152691
dc.description.abstract	<h4>Problem and background</h4>Caesarean section (CS) rates in Australia and many countries worldwide are high and increasing, with elective repeat caesarean section a significant contributor.<h4>Aim</h4>To determine whether midwifery continuity of care for women with a previous CS increases the proportion of women who plan to attempt a vaginal birth in their current pregnancy.<h4>Methods</h4>A randomised controlled design was undertaken. Women who met the inclusion criteria were randomised to one of two groups; the Community Midwifery Program (CMP) (continuity across the full spectrum - antenatal, intrapartum and postpartum) (n=110) and the Midwifery Antenatal Care (MAC) Program (antenatal continuity of care) (n=111) using a remote randomisation service. Analysis was undertaken on an intention to treat basis. The primary outcome measure was the rate of attempted vaginal birth after caesarean section and secondary outcomes included composite measures of maternal and neonatal wellbeing.<h4>Findings</h4>The model of care did not significantly impact planned vaginal birth at 36 weeks (CMP 66.7% vs MAC 57.3%) or success rate (CMP 27.8% vs MAC 32.7%). The rate of maternal and neonatal complications was similar between the groups.<h4>Conclusion</h4>Model of care did not significantly impact the proportion of women attempting VBAC in this study. The similarity in the number of midwives seen antenatally and during labour and birth suggests that these models of care had more similarities than differences and that the model of continuity could be described as informational continuity. Future research should focus on the impact of relationship based continuity of care.
dc.format	Print-Electronic
dc.language	eng
dc.publisher	Elsevier BV
dc.relation.ispartof	Women and birth : journal of the Australian College of Midwives
dc.relation.isbasedon	10.1016/j.wombi.2021.05.010
dc.rights	info:eu-repo/semantics/embargoedAccess
dc.subject	11 Medical and Health Sciences
dc.subject.classification	Obstetrics & Reproductive Medicine
dc.title	Midwifery continuity of care and vaginal birth after caesarean section: A randomised controlled trial.
dc.type	Journal Article
utslib.location.activity	Netherlands
utslib.for	11 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/Strength - CHSP - Health Services and Practice
pubs.organisational-group	/University of Technology Sydney/Strength - WHO CC
pubs.organisational-group	/University of Technology Sydney/Faculty of Health/Midwifery
utslib.copyright.status	open_access	*
utslib.copyright.embargo	2023-06-01T00:00:00+1000Z
dc.date.updated	2022-01-05T04:20:13Z
pubs.publication-status	Published

Abstract:

Problem and background

Caesarean section (CS) rates in Australia and many countries worldwide are high and increasing, with elective repeat caesarean section a significant contributor.

Aim

To determine whether midwifery continuity of care for women with a previous CS increases the proportion of women who plan to attempt a vaginal birth in their current pregnancy.

Methods

A randomised controlled design was undertaken. Women who met the inclusion criteria were randomised to one of two groups; the Community Midwifery Program (CMP) (continuity across the full spectrum - antenatal, intrapartum and postpartum) (n=110) and the Midwifery Antenatal Care (MAC) Program (antenatal continuity of care) (n=111) using a remote randomisation service. Analysis was undertaken on an intention to treat basis. The primary outcome measure was the rate of attempted vaginal birth after caesarean section and secondary outcomes included composite measures of maternal and neonatal wellbeing.

Findings

The model of care did not significantly impact planned vaginal birth at 36 weeks (CMP 66.7% vs MAC 57.3%) or success rate (CMP 27.8% vs MAC 32.7%). The rate of maternal and neonatal complications was similar between the groups.

Conclusion

Model of care did not significantly impact the proportion of women attempting VBAC in this study. The similarity in the number of midwives seen antenatally and during labour and birth suggests that these models of care had more similarities than differences and that the model of continuity could be described as informational continuity. Future research should focus on the impact of relationship based continuity of care.

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

http://hdl.handle.net/10453/152691