The association between attendance of midwives and workload of midwives with the mode of birth: secondary analyses in the German healthcare system

BMC Pregnancy and Childbirth

Friederike zu Sayn-Wittgenstein¹  Wilfried Schnepp³  Herbert Mayer²  Nina Knape¹ 

[1]University of Applied Sciences Osnabrueck, Faculty of Business Management and Social Sciences, Network of Midwifery Research, P.O. 1940, D-49009 Osnabrueck, Germany

[2]University of Applied Sciences Rheine, Frankenburgstraße 31, D-48431 Rheine, Germany

[3]Department of Nursing Science, University of Witten/Herdecke, Faculty of Health, Stockumer Str.12, D-58453 Witten, Germany

关键词: Operative delivery;    Mode of birth;    Caesarean;    Continuity;    Intrapartum care;    Supportive care;    One-to-one;    Workload;    Attendance;    Midwife;   

Others  :  1125555
DOI  :  10.1186/1471-2393-14-300

 received in 2013-12-16, accepted in 2014-08-26,  发布年份 2014

【 摘 要 】

Background

The continuous rise in caesarean rates across most European countries raises multiple concerns. One factor in this development might be the type of care women receive during childbirth. ‘Supportive care during labour’ by midwives could be an important factor for reducing fear, tension and pain and decreasing caesarean rates. The presence and availability of midwives to support a woman in line with her needs are central aspects for ‘supportive care during labour’.

To date, there is no existing research on the influence of effective ‘supportive care’ by German midwives on the mode of birth. This study examines the association between the attendance and workload of midwives with the mode of birth outcomes in a population of low-risk women in a German multicentre sample.

Methods

The data are based on a prospective controlled multicentre trial (n = 1,238) in which the intervention ‘midwife-led care’ was introduced. Four German hospitals participated between 2007 and 2009.

Secondary analyses included a convenience sample of 999 low-risk women from the primary analyses who met the selection criterion ‘low-risk status’. Participation was voluntary. The association between the mode of birth and the key variables ‘attendance of midwives’ and ‘workload of midwives’ was assessed using backward logistic regression models.

Results

The overall rate of spontaneous delivery was 80.7% (n = 763). The ‘attendance of midwives’ and the ‘workload of midwives’ did not exhibit a significant association with the mode of birth. However, women who were not satisfied with the presence of midwives (OR: 2.45, 95% CI 1.54-3.95) or who did not receive supportive procedures by midwives (OR: 3.01, 95% CI 1.50-6.05) were significantly more likely to experience operative delivery or a caesarean. Further explanatory variables include the type of hospital, participation in childbirth preparation class, length of stay from admission to birth, oxytocin usage and parity.

Conclusion

Satisfaction with the presence of and supportive procedures by midwives are associated with the mode of birth. The presence and behaviour of midwives should suit the woman’s expectations and fulfil her needs. For reasons of causality, we would recommend experimental or quasi-experimental research that would exceed the explorative character of this study.

【 授权许可】

   
2014 Knape et al.; licensee BioMed Central Ltd.

【 图 表 】

Figure 1.

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