Does model of maternity care make a difference to birth outcomes for young women? A retrospective cohort study. Issue 8 (August 2015)

• Record Type: Journal Article
• Authors: Allen, Jyai; Gibbons, Kristen; Beckmann, Michael; Tracy, Mark; Stapleton, Helen; Kildea, Sue
• Is Part Of: International journal of nursing studies. Volume 52:Issue 8(2015:Aug.)
• Page Start: 1332
• Page End: 1342
• Publication Date: 2015-08
• Subjects: Nursing -- Periodicals; Nursing -- Periodicals; Soins infirmiers -- Périodiques; Nursing; Periodicals; 610.73
• DOI: 10.1016/j.ijnurstu.2015.04.011
• Languages: English
• ISSNs: 0020-7489

Abstract

<abstract abstract-type="author" id="abs0005"> <title id="sect0005">Abstract</title> <sec> <title id="sect0010">Background</title> <p id="spar0005">Adolescent pregnancy is associated with adverse outcomes including preterm birth, admission to the neonatal intensive care unit, low birth weight infants, and artificial feeding.</p> </sec> <sec> <title id="sect0015">Objective</title> <p id="spar0010">To determine if caseload midwifery or young women's clinic are associated with improved perinatal outcomes when compared to standard care.</p> </sec> <sec> <title id="sect0020">Design</title> <p id="spar0015">A retrospective cohort study.</p> </sec> <sec> <title id="sect0025">Setting</title> <p id="spar0020">A tertiary Australian hospital where routine maternity care is delivered alongside two community-based maternity care models specifically for young women aged 21 years or less: caseload midwifery (known midwife) and young women's clinic (rostered midwife).</p> </sec> <sec> <title id="sect0030">Participants</title> <p id="spar0025">All pregnant women aged 21 years or less, with a singleton pregnancy, who attended a minimum of two antenatal visits, and who birthed a baby (without congenital abnormality) at the study hospital during May 2008 to December 2012.</p> </sec> <sec> <title id="sect0035">Methods</title> <p id="spar0030">Caseload midwifery and young women's clinic were each compared to standard maternity care, but not with each other, for four primary outcomes: preterm birth (<37 weeks gestation), low birth weight infants (<2500 g), neonatal intensive care unit admission, and breastfeeding initiation. Two analyses were performed on the primary outcomes to examine potential associations between maternity care type and perinatal outcomes: intention-to-treat (model of care at booking) and treatment-received (model of care on admission for labour/birth).</p> </sec> <sec> <title id="sect0040">Results</title> <p id="spar0035">1908 births were analysed by intention-to-treat and treatment-received analyses. Young women allocated to caseload care at booking, compared to standard care, were less likely to have a preterm birth (adjusted odds ratio 0.59 (0.38–0.90, <italic>p</italic> = 0.014)) or a neonatal intensive care unit admission adjusted odds ratio 0.42 (0.22–0.82, <italic>p</italic> = 0.010). Rates of low birth weight infants and breastfeeding initiation were similar between caseload and standard care participants.</p> <p id="spar0040">Participants allocated to young women's clinic at booking, compared to standard care, were less likely to have a low birth weight infant adjusted odds ratio 0.49 (0.24–1.00, <italic>p</italic> = 0.049), however when analysed by treatment-received, this finding was not significant. There was no difference in the other primary outcomes.</p> </sec> <sec> <title id="sect0045">Conclusions</title> <p id="spar0045">Young women who were allocated to caseload midwifery at booking, and/or were receiving caseload midwifery at the time of admission for birth, were less likely to experience preterm birth and neonatal intensive care unit admission.</p> </sec> </abstract>