Child and maternal benefits and risks of caseload midwifery – a systematic review and meta-analysis

Abstract Background It has been reported that caseload midwifery, which implies continuity of midwifery care during pregnancy, childbirth, and the postnatal period, improves the outcomes for the mother and child. The aim of this study was to review benefits and risks of caseload midwifery, compared...

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Main Authors: Lotta Wassén, Beata Borgström Bolmsjö, Sophia Frantz, Anna Hagman, Marie Lindroth, Christine Rubertsson, Annika Strandell, Therese Svanberg, Anna Wessberg, Susanna M. Wallerstedt
Format: Article
Language:English
Published: BMC 2023-09-01
Series:BMC Pregnancy and Childbirth
Subjects:
Online Access:https://doi.org/10.1186/s12884-023-05967-x
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author Lotta Wassén
Beata Borgström Bolmsjö
Sophia Frantz
Anna Hagman
Marie Lindroth
Christine Rubertsson
Annika Strandell
Therese Svanberg
Anna Wessberg
Susanna M. Wallerstedt
author_facet Lotta Wassén
Beata Borgström Bolmsjö
Sophia Frantz
Anna Hagman
Marie Lindroth
Christine Rubertsson
Annika Strandell
Therese Svanberg
Anna Wessberg
Susanna M. Wallerstedt
author_sort Lotta Wassén
collection DOAJ
description Abstract Background It has been reported that caseload midwifery, which implies continuity of midwifery care during pregnancy, childbirth, and the postnatal period, improves the outcomes for the mother and child. The aim of this study was to review benefits and risks of caseload midwifery, compared with standard care comparable to the Swedish setting where the same midwife usually provides antenatal care and the checkup postnatally, but does not assist during birth and the first week postpartum. Methods Medline, Embase, Cinahl, and the Cochrane Library were searched (Nov 4th, 2021) for randomized controlled trials (RCTs). Retrieved articles were assessed and pooled risk ratios calculated when possible, using random-effects meta-analyses. Certainty of evidence was assessed according to GRADE. Results In all, 7,594 patients in eight RCTs were included, whereof five RCTs without major risk of bias, including 5,583 patients, formed the basis for the conclusions. There was moderate certainty of evidence for little or no difference regarding the risk of Apgar ≤ 7 at 5 min, instrumental birth, and preterm birth. There was low certainty of evidence for little or no difference regarding the risk of perinatal mortality, neonatal intensive care, perineal tear, bleeding, and acute caesarean section. Caseload midwifery may reduce the overall risk of caesarean section. Regarding breastfeeding after hospital discharge, maternal mortality, maternal morbidity, health-related quality of life, postpartum depression, health care experience/satisfaction and confidence, available studies did not allow conclusions (very low certainty of evidence). For severe child morbidity and Apgar ≤ 4 at 5 min, there was no literature available. Conclusions When caseload midwifery was compared with models of care that resembles the Swedish one, little or no difference was found for several critical and important child and maternal outcomes with low-moderate certainty of evidence, but the risk of caesarean section may be reduced. For several outcomes, including critical and important ones, studies were lacking, or the certainty of evidence was very low. RCTs in relevant settings are therefore required.
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spelling doaj.art-0a68e5cce6f440269cf419e5a0baa2672023-11-20T11:14:13ZengBMCBMC Pregnancy and Childbirth1471-23932023-09-0123111110.1186/s12884-023-05967-xChild and maternal benefits and risks of caseload midwifery – a systematic review and meta-analysisLotta Wassén0Beata Borgström Bolmsjö1Sophia Frantz2Anna Hagman3Marie Lindroth4Christine Rubertsson5Annika Strandell6Therese Svanberg7Anna Wessberg8Susanna M. Wallerstedt9Department of Obstetrics and Gynecology, Sahlgrenska University HospitalDepartment Research and education, HTA syd, Skåne University HospitalDepartment Research and education, HTA syd, Skåne University HospitalRegional Healthcare, Region Västra GötalandMidwifery Clinic in Primary Care, Region SkåneDepartment of Health Science, Medical faculty, Lund UniversityDepartment of Obstetrics and Gynecology, Sahlgrenska University HospitalMedical library, Sahlgrenska University HospitalDepartment of Obstetrics and Gynecology, Sahlgrenska University HospitalHTA-centrum, Sahlgrenska University Hospital, Region Västra GötalandAbstract Background It has been reported that caseload midwifery, which implies continuity of midwifery care during pregnancy, childbirth, and the postnatal period, improves the outcomes for the mother and child. The aim of this study was to review benefits and risks of caseload midwifery, compared with standard care comparable to the Swedish setting where the same midwife usually provides antenatal care and the checkup postnatally, but does not assist during birth and the first week postpartum. Methods Medline, Embase, Cinahl, and the Cochrane Library were searched (Nov 4th, 2021) for randomized controlled trials (RCTs). Retrieved articles were assessed and pooled risk ratios calculated when possible, using random-effects meta-analyses. Certainty of evidence was assessed according to GRADE. Results In all, 7,594 patients in eight RCTs were included, whereof five RCTs without major risk of bias, including 5,583 patients, formed the basis for the conclusions. There was moderate certainty of evidence for little or no difference regarding the risk of Apgar ≤ 7 at 5 min, instrumental birth, and preterm birth. There was low certainty of evidence for little or no difference regarding the risk of perinatal mortality, neonatal intensive care, perineal tear, bleeding, and acute caesarean section. Caseload midwifery may reduce the overall risk of caesarean section. Regarding breastfeeding after hospital discharge, maternal mortality, maternal morbidity, health-related quality of life, postpartum depression, health care experience/satisfaction and confidence, available studies did not allow conclusions (very low certainty of evidence). For severe child morbidity and Apgar ≤ 4 at 5 min, there was no literature available. Conclusions When caseload midwifery was compared with models of care that resembles the Swedish one, little or no difference was found for several critical and important child and maternal outcomes with low-moderate certainty of evidence, but the risk of caesarean section may be reduced. For several outcomes, including critical and important ones, studies were lacking, or the certainty of evidence was very low. RCTs in relevant settings are therefore required.https://doi.org/10.1186/s12884-023-05967-xCaseload midwiferyGRADEMeta-analysisCare modelSystematic review
spellingShingle Lotta Wassén
Beata Borgström Bolmsjö
Sophia Frantz
Anna Hagman
Marie Lindroth
Christine Rubertsson
Annika Strandell
Therese Svanberg
Anna Wessberg
Susanna M. Wallerstedt
Child and maternal benefits and risks of caseload midwifery – a systematic review and meta-analysis
BMC Pregnancy and Childbirth
Caseload midwifery
GRADE
Meta-analysis
Care model
Systematic review
title Child and maternal benefits and risks of caseload midwifery – a systematic review and meta-analysis
title_full Child and maternal benefits and risks of caseload midwifery – a systematic review and meta-analysis
title_fullStr Child and maternal benefits and risks of caseload midwifery – a systematic review and meta-analysis
title_full_unstemmed Child and maternal benefits and risks of caseload midwifery – a systematic review and meta-analysis
title_short Child and maternal benefits and risks of caseload midwifery – a systematic review and meta-analysis
title_sort child and maternal benefits and risks of caseload midwifery a systematic review and meta analysis
topic Caseload midwifery
GRADE
Meta-analysis
Care model
Systematic review
url https://doi.org/10.1186/s12884-023-05967-x
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