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Midwife managed delivery unit: a randomised controlled comparison with consultant led care

BMJ 1994; 309 doi: http://dx.doi.org/10.1136/bmj.309.6966.1400 (Published 26 November 1994) Cite this as: BMJ 1994;309:1400
  1. V A Hundley, research fellowa,
  2. F M Cruickshank, research sister, Aberdeen Maternity Hospitalb,
  3. G D Lang, consultant obstetriciana,
  4. C M A Glazener, Wellcome research fellow in postnatal carec,
  5. J M Milne, nurse manager, directorate of obstetrics and gynaecologyb,
  6. M Turner, project assistanta,
  7. D Blyth, research assistanta,
  8. J Mollison, research assistantc,
  9. C Donaldson, deputy directord
  1. a Department of Obstetrics and Gynaecology, University of Aberdeen, Aberdeen Maternity Hospital, Aberdeen AB9 2ZA
  2. b Aberdeen Royal Hospitals NHS Trust, Aberdeen AB9 2ZA
  3. c Health Services Research Unit, University of Aberdeen, Foresterhill, Aberdeen AB9 2ZD
  4. d Health Economics Research Unit, Department of Public Health, University of Aberdeen, Foresterhill, Aberdeen AB9 2ZD
  1. Correspondence to: Ms Hundley.
  • Accepted 4 October 1994

Abstract

Objective: To examine whether intrapartum care and delivery of low risk women in a midwife managed delivery unit differs from that in a consultant led labour ward.

Design: Pragmatic randomised controlled trial. Subjects were randomised in a 2:1 ratio between the midwives unit and the labour ward.

Setting: Aberdeen Maternity Hospital, Grampian. Subjects—2844 low risk women, as defined by existing booking criteria for general practitioner units in Grampian. 1900 women were randomised to the midwives unit and 944 to the labour ward.

Main outcome measures: Maternal and perinatal morbidity.

Results: Of the women randomised to the midwives unit, 647 (34%) were transferred to the labour ward antepartum, 303 (16%) were transferred intrapartum, and 80 (4%) were lost to follow up. 870 women (46%) were delivered in the midwives unit. Primigravid women (255/596, 43%) were significantly more likely to be transferred intrapartum than multigravid women (48/577, 8%). Significant differences between the midwives unit and labour ward were found in monitoring, fetal distress, analgesia, mobility, and use of episiotomy. There were no significant differences in mode of delivery or fetal outcome.

Conclusions: Midwife managed intrapartum care for low risk women results in more mobility and less intervention with no increase in neonatal morbidity. However, the high rate of transfer shows that antenatal criteria are unable to determine who will remain at low risk throughout pregnancy and labour.

Footnotes

    • Accepted 4 October 1994
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