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Evaluating a Midwife‐Led Model of Antenatal Care for Women with a Previous Cesarean Section: A Retrospective, Comparative Cohort Study
Author(s) -
White Helen K.,
May Andrée,
Cluett Elizabeth R.
Publication year - 2016
Publication title -
birth
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.233
H-Index - 83
eISSN - 1523-536X
pISSN - 0730-7659
DOI - 10.1111/birt.12229
Subject(s) - medicine , obstetrics , retrospective cohort study , logistic regression , odds ratio , psychological intervention , confounding , odds , obstetrics and gynaecology , pregnancy , nursing , pathology , biology , genetics
Background Research is yet to identify effective and safe interventions to increase the vaginal birth after cesarean ( VBAC ) rate. This research aimed to compare intended and actual VBAC rates before and after implementation of midwife‐led antenatal care for women with one previous cesarean birth and no other risk factors in a large, tertiary maternity hospital in England. Methods This was a retrospective, comparative cohort study. Data were collected from the medical records of women with one previous lower segment cesarean delivery and no other obstetric, medical, or psychological complications who gave birth at the hospital before (2008) and after (2011) the implementation of midwife‐led antenatal care. Chi‐squared analysis was used to calculate the odds ratio, and logistic regression to account for confounders. Results Intended and actual VBAC rates were higher in 2011 compared with 2008: 90 percent vs. 77 percent, adjusted odds ratio ( aOR ) 2.69 (1.48–4.87); and 61 percent vs. 47 percent, aOR 1.79 (1.17–2.75), respectively. Mean rates of unscheduled antenatal care sought via the delivery suite and inpatient admissions were lower in 2011 than 2008. Postnatal maternal and neonatal safety outcomes were similar between the two groups, except mean postnatal length of stay, which was shorter in 2011 compared with 2008 (2.67 vs. 3.15 days). Conclusions Implementation of midwife‐led antenatal care for women with one previous cesarean offers a safe and effective alternative to traditional obstetrician‐led antenatal care, and is associated with increased rates of intended and actual VBAC .