Caseload midwifery for women at low risk of medical complications: a randomised controlled trial

INTERVENTION: The intervention is caseload midwifery. Women allocated to the intervention will receive antenatal, intrapartum and postpartum care from a known midwife with one or two antenatal visits conducted by a ‘back‐up’ midwife. The midwife will collaborate with obstetricians and other health professionals as necessary. If the woman has an extended labour, or if the primary midwife is unavailable, care will be provided by the back‐up midwife. Each midwife will be allocated a group of women to care for in this way (a caseload). The intervention is from the pregnancy booking visit until 5 days after birth (approximately 6‐7 months). CONDITION: Maternity model of care PRIMARY OUTCOME: To determine whether caseload (one on one) midwifery care for women at low risk of medical complications decreases the proportion of women having a caesarean section birth, compared with women in ‘standard’ care models (19 compared with 14%). SECONDARY OUTCOME: A higher proportion of breastfeeding Decreased postnatal depression Decreased smoking Increased satisfaction with care Other outcomes collected will include measures of perinatal and maternal morbidity and mortality. To test if midwives providing caseload care have decreased staff attrition and increased work satisfaction. To test if the model is cost neutral and/or cost effective To test if women receiving caseload care have: decreased rates of instrumental vaginal births, obstetric analgesia, perineal trauma and induction of labour (measures from birth record). INCLUSION CRITERIA: Low‐medical risk at recruitment;‐ English‐speaking: able to speak, read and write in English;‐ Less than 24 completed weeks gestation at recruitment.‐ of childbearing age (on average 18‐45 years, but women could be yournger or older than this providing all other eligibility criteria are met).