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Improving Maternal and Neonatal Health by a Midwife-led Continuity Model of Care – An Observational Study in One Governmental Hospital in Palestine
BACKGROUND: From 2013 a midwife-led continuity model of care was implemented in the Nablus region in occupied Palestine, involving a governmental hospital and ten rural villages. This study analysed the relation between the midwife-led model and maternal and neonatal health outcomes. METHOD: A regis...
Autores principales: | , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
Elsevier
2019
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6543174/ https://www.ncbi.nlm.nih.gov/pubmed/31193799 http://dx.doi.org/10.1016/j.eclinm.2019.04.003 |
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author | Mortensen, Berit Lieng, Marit Diep, Lien My Lukasse, Mirjam Atieh, Kefaya Fosse, Erik |
author_facet | Mortensen, Berit Lieng, Marit Diep, Lien My Lukasse, Mirjam Atieh, Kefaya Fosse, Erik |
author_sort | Mortensen, Berit |
collection | PubMed |
description | BACKGROUND: From 2013 a midwife-led continuity model of care was implemented in the Nablus region in occupied Palestine, involving a governmental hospital and ten rural villages. This study analysed the relation between the midwife-led model and maternal and neonatal health outcomes. METHOD: A register-based, retrospective cohort design was used, involving 2201 singleton births between January 2016 and June 2017 at Nablus governmental hospital. Data from rural women, with singleton pregnancies and mixed risk status, who either lived in villages that offered the midwife-led continuity model and had registered at the governmental clinic, or who lived in villages without the midwife-led model and received regular care, were compared. Primary outcome was unplanned caesarean section. Secondary outcomes were other modes of birth, postpartum anaemia, preterm birth, birth weight, and admission to neonatal intensive care unit. FINDINGS: Statistically significant less women receiving the midwife-led model had unplanned caesarean sections, 12·8% vs 15·9%, adjusted risk ratio (aRR) 0·80 (95% CI 0·64–0·99) and postpartum anaemia,19·8% vs 28·6%, aRR 0·72 (0·60–0·85). There was also a statistically significant lower rate of preterm births within the exposed group, 13·1% vs 16·8, aRR 0·79 (0·63–0·98), admission to neonatal intensive care unit, 7·0% vs 9·9%, aRR 0·71 (0·52–0·98) and newborn with birth weight 1500 g and less, 0·1% vs 1·1%, aRR 0·13 (0·02–0·97). INTERPRETATION: Receiving the midwife-led continuity model of care in Palestine was associated with several improved maternal and neonatal health outcomes. The findings support further implementation of the model. Implementation research, including randomised studies, would be useful to further investigate the effect and feasibility of the model in a low resource setting. FUNDING: This study was partly funded by the Research Council of Norway through the Global Health and Vaccination Program (GLOBVAC), project number 243706. The implementation received public funding through Norwegian Aid Committee (NORWAC). |
format | Online Article Text |
id | pubmed-6543174 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2019 |
publisher | Elsevier |
record_format | MEDLINE/PubMed |
spelling | pubmed-65431742019-06-04 Improving Maternal and Neonatal Health by a Midwife-led Continuity Model of Care – An Observational Study in One Governmental Hospital in Palestine Mortensen, Berit Lieng, Marit Diep, Lien My Lukasse, Mirjam Atieh, Kefaya Fosse, Erik EClinicalMedicine Research Paper BACKGROUND: From 2013 a midwife-led continuity model of care was implemented in the Nablus region in occupied Palestine, involving a governmental hospital and ten rural villages. This study analysed the relation between the midwife-led model and maternal and neonatal health outcomes. METHOD: A register-based, retrospective cohort design was used, involving 2201 singleton births between January 2016 and June 2017 at Nablus governmental hospital. Data from rural women, with singleton pregnancies and mixed risk status, who either lived in villages that offered the midwife-led continuity model and had registered at the governmental clinic, or who lived in villages without the midwife-led model and received regular care, were compared. Primary outcome was unplanned caesarean section. Secondary outcomes were other modes of birth, postpartum anaemia, preterm birth, birth weight, and admission to neonatal intensive care unit. FINDINGS: Statistically significant less women receiving the midwife-led model had unplanned caesarean sections, 12·8% vs 15·9%, adjusted risk ratio (aRR) 0·80 (95% CI 0·64–0·99) and postpartum anaemia,19·8% vs 28·6%, aRR 0·72 (0·60–0·85). There was also a statistically significant lower rate of preterm births within the exposed group, 13·1% vs 16·8, aRR 0·79 (0·63–0·98), admission to neonatal intensive care unit, 7·0% vs 9·9%, aRR 0·71 (0·52–0·98) and newborn with birth weight 1500 g and less, 0·1% vs 1·1%, aRR 0·13 (0·02–0·97). INTERPRETATION: Receiving the midwife-led continuity model of care in Palestine was associated with several improved maternal and neonatal health outcomes. The findings support further implementation of the model. Implementation research, including randomised studies, would be useful to further investigate the effect and feasibility of the model in a low resource setting. FUNDING: This study was partly funded by the Research Council of Norway through the Global Health and Vaccination Program (GLOBVAC), project number 243706. The implementation received public funding through Norwegian Aid Committee (NORWAC). Elsevier 2019-04-16 /pmc/articles/PMC6543174/ /pubmed/31193799 http://dx.doi.org/10.1016/j.eclinm.2019.04.003 Text en © 2019 Published by Elsevier Ltd. http://creativecommons.org/licenses/by-nc-nd/4.0/ This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/). |
spellingShingle | Research Paper Mortensen, Berit Lieng, Marit Diep, Lien My Lukasse, Mirjam Atieh, Kefaya Fosse, Erik Improving Maternal and Neonatal Health by a Midwife-led Continuity Model of Care – An Observational Study in One Governmental Hospital in Palestine |
title | Improving Maternal and Neonatal Health by a Midwife-led Continuity Model of Care – An Observational Study in One Governmental Hospital in Palestine |
title_full | Improving Maternal and Neonatal Health by a Midwife-led Continuity Model of Care – An Observational Study in One Governmental Hospital in Palestine |
title_fullStr | Improving Maternal and Neonatal Health by a Midwife-led Continuity Model of Care – An Observational Study in One Governmental Hospital in Palestine |
title_full_unstemmed | Improving Maternal and Neonatal Health by a Midwife-led Continuity Model of Care – An Observational Study in One Governmental Hospital in Palestine |
title_short | Improving Maternal and Neonatal Health by a Midwife-led Continuity Model of Care – An Observational Study in One Governmental Hospital in Palestine |
title_sort | improving maternal and neonatal health by a midwife-led continuity model of care – an observational study in one governmental hospital in palestine |
topic | Research Paper |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6543174/ https://www.ncbi.nlm.nih.gov/pubmed/31193799 http://dx.doi.org/10.1016/j.eclinm.2019.04.003 |
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