A randomised controlled trial of caseload midwifery care

INTERVENTION: Caseload midwifery care: Women allocated to the caseload intervention will receive antenatal, intrapartum and postpartum care from a primary caseload midwife with one or two antenatal visits to be conducted by a ‘backup’ midwife. Caseload midwives work in group practices of four full time midwives each working a cycle of 152 hours during each four week period. The primary midwife is on call for the woman’s labour and birth except in designated circumstances such as annual leave; sick leave; having more than one woman in labour; or if it is on one of the two days per week that the primary midwife is scheduled to not work or be on call. Care will then be provided by a back‐up midwife. The primary midwife will collaborate with obstetricians and other health professionals as necessary, and will continue to provide caseload care in addition to care provided by obstetricians if complications develop. In addition to providing care until after the birth of the baby, the primary midwife (or a back up midwife) will attend the hospital on most days to provide some postnatal care and will provide domiciliary care following discharge from hospital. Care will be provided according to hospital guidelines and protocols for up to six weeks following birth. CONDITION: Care during childbirth the reorganisation of midwifery care PRIMARY OUTCOME: The proportion of instrumental vaginal births the proportion of women having a ; caesarean section birth. the proportion of women having an unassisted vaginal birth SECONDARY OUTCOME: rates of neonatal morbidity (including admission to the neonatal intensive care unit), Satisfaction with care Staff attrition and satisfaction the proportion of women having Induction of labour and augmentation of labour the proportion of women having Obstetric analgesia the proportion of women having perineal trauma To determine whether caseload midwifery care costs the same as routine ; maternity care. INCLUSION CRITERIA: Women will be eligible for trial entry if they are less than 24 completed weeks of pregnancy at booking in