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A retrospective cohort study of the association between midwifery experience and perinatal mortality
Author(s) -
Lawton Beverley,
Filoche Sara,
Geller Stacie E.,
Garrett Sue,
Stanley James
Publication year - 2016
Publication title -
international journal of gynecology and obstetrics
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.895
H-Index - 97
eISSN - 1879-3479
pISSN - 0020-7292
DOI - 10.1016/j.ijgo.2015.07.003
Subject(s) - medicine , perinatal mortality , obstetrics , retrospective cohort study , pregnancy , confidence interval , infant mortality , cohort study , cohort , nursing , fetus , population , environmental health , genetics , pathology , biology
Objective To determine whether experience of midwife‐only and nurse‐midwife lead maternity carers (LMCs) is related to perinatal mortality. Methods In a retrospective analysis, routinely collected data were obtained for all pregnancies resulting in live births (or stillbirth at ≥ 20 weeks or weighing > 400 g) in New Zealand in 2005–2009. An anonymized dataset of date of midwife registration was used. The main outcome measure was perinatal mortality (fetal deaths and neonatal deaths ≤ 27 days). Results Among 233 215 eligible births, 84 043 were linked to a midwife‐only LMC and 150 172 to a nurse‐midwife LMC. Among pregnancies with midwife‐only LMCs, perinatal mortality was higher when the midwife had less than 1 year of experience than when the midwife had 5–9 years’ experience (rate ratio 1.33; 95% confidence interval 1.02–1.73), an absolute difference of two additional deaths per 1000 births. There was a decreasing rate of perinatal mortality with increasing experience ( P = 0.031). Perinatal mortality rates did not differ by experience in the nurse‐midwife group. Conclusion Pregnancies cared for by early‐career (< 1 year) midwife‐only LMCs were associated with a 33% increase in perinatal mortality. No association between experience and perinatal mortality was found for nurse‐midwives. Midwife‐only trained LMCs could require additional training and/or supervision in their first year of practice.