A comparison between midwifery and obstetric care at birth in Spain: Across-sectional study of perinatal outcomes.

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Publisher: Elsevier B.V.
Document Type: Report
Length: 551 words

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Keywords Midwifery care; Obstetric care; Low-risk birth; Perinatal outcomes; Mode of birth; Cross-sectional study Abstract Background The organizational structure of maternity services determines the choice of which professionals provide care during pregnancy, birth, and the postnatal period, and it influences the kind of care they deliver and the level of continuity of care offered. There is considerable evidence that demonstrates a relationship between how care is provided and the maternal and neonatal health outcomes. Registered midwives and obstetricians provide maternity care across Spain. To date, no studies have assessed whether maternity outcomes differ between these two groups. Objective The aim of this study was to examine the association between the care received (midwifery care versus obstetric care) and the maternal and neonatal outcomes in women with normal, low- and medium-risk pregnancies in Spain from 2016 to 2019. Design A prospective, multicentre, cross-sectional study was carried out as part of COST Action IS1405 at 44 public hospitals in Spain in the years 2016--2019. The protocol can be accessed through the registry ISRCTN14062994. The sample size of this study was 11,537 women. The primary outcome was mode of birth. The secondary outcomes included augmentation with oxytocin, use of epidural analgesia, women's position at birth, perineal integrity, third stage of labour management, maternal and neonatal admission to intensive care, Apgar score, neonatal resuscitation, and early initiation of breastfeeding. Chi-square tests for categorical variables and independent sample t-test for continuous variables to assess differences between the midwifery and obstetric groups were calculated. Odds ratio with intervals of confidence at 95% were calculated for obstetric interventions and perinatal outcomes. A multivariate logistic regression model was applied in order to examine the effect of type of healthcare provider on perinatal outcomes. These models were adjusted for care provider, type of onset of labour, use of anaesthesia, pregnancy risk, maternal age, parity, and gestational age at birth. Results Midwifery care was associated with lower rates of operative births and severe perineal damage and had no higher adverse outcomes. No statistically significant differences were observed in the use of other obstetric interventions between the two groups. Conclusions The findings of this study should encourage a shift in the current maternity care system towards a greater integration of midwifery-led services in order to achieve optimal birth outcomes for women and newborns. Registry number ISRCTN14062994 Author Affiliation: (a) Faculty of Medicine, Nursing Department, Universidad Autónoma de Madrid, Calle Arzobispo Morcillo 4, 28029 Madrid, Spain (b) Ghenders research group. School of Health Sciences Blanquerna, Universitat Ramon Lull, Carrer Padilla 326, 08025 Barcelona, Spain (c) Catalan Health Service, Government of Barcelona, Travessera de les Corts 131, 08028 Barcelona, Spain (d) Gimbernat School of Nursing, Universitat Autònoma de Barcelona (UAB), Sant Cugat del Vallès, Spain (e) La Ribera Hospital Health Department, Carretera Corbera km 1, 46600 Alzira, Valencia, Spain (f) Faculty of Nursing and Podiatry, Universitat de València, Jaume Roig, s/n, 46010 Valencia, Spain (g) Foundation for the Promotion of Health and Biomedical Research in the Valencian Region (FISABIO), Valencia, Spain * Corresponding author at: School of Health Sciences Blanquerna, Universitat Ramon Lull, Carrer Padilla 326, 08025 Barcelona, Spain. Article History: Received 20 March 2021; Revised 14 October 2021; Accepted 29 October 2021 Byline: Anna Martin-Arribas [annama7@blanquerna.url.edu] (a,b,*), Ramon Escuriet [rescuriet@gencat.cat] (b,c), Alicia Borràs-Santos [alicia.borras@eug.es] (d), Rafael Vila-Candel [vila_rafcan@gva.es] (e,f,g), Cristina González-Blázquez [cristina.gonzalez01@uam.es] (a)

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Gale Document Number: GALE|A689867773