Caseload midwifery for women at low risk of medical complications: a randomised controlled trial

2004年6月，维多利亚州人类服务部发布了一份政策文件《维多利亚州产妇服务的未来方向》。该文件赞同扩大提供“一对一”助产护理（病例量）的公共产科护理模式。该模型的评价有限，安全性和有效性很大程度上未知。在英国和澳大利亚进行的研究在很大程度上衡量了护理提供者团队（通常为6-12名助产士）的效果，而在英国只有两个测试病例护理。关于助产队连续性的研究报告说，剖腹产和其他分娩干预措施减少了。他们还发现满意度提高了，婴儿的健康结果没有统计学上的显著差异。被确定为低医疗风险的妇女将从大型三级公立妇产医院的产前诊所招募。妇女将被随机分配到病例负荷助产或标准低风险护理。那些被分配到病例负荷的人将接受初级助产士的妊娠、分娩和产后护理，并由一名“后备”助产士进行一到两次妊娠就诊。必要时，助产士将与产科医生和其他保健专业人员合作。这将是澳大利亚第一个病例负荷助产护理的随机对照试验，也是第三个在任何地方进行的随机对照试验。这是对一个开始在澳大利亚广泛实施的模式进行严格评估的独特机会。该试验将提供关于病例助产结果的急需信息，包括分娩干预措施、安全性、成本、妇女对护理的满意度以及对助产人员的影响。该研究将提供的数据将告知临床实践和指导服务提供者参与组织产妇服务。

In June 2004, the Victorian Department of Human Services released a policy document Future directions for Victoria's maternity services. The document endorsed the expansion of public models of maternity care that offer 'one on one' midwifery care (caseload). This model has had limited evaluation with safety and efficacy largely unknown. Research conducted in the UK and in Australia has largely measured the effect of teams of care providers (commonly 6-12 midwives) with only two in the UK testing caseload care. Studies of continuity of midwifery teams have reported reduced caesareans and other interventions in labour. They have also found increased satisfaction, with no statistically significant differences in health outcomes for babies. Women who are identified at low medical risk will be recruited from the antenatal clinic of a large, tertiary, public maternity hospital. Women will be randomly allocated to caseload midwifery or standard low risk care. Those allocated to caseload will receive pregnancy, birth and postnatal care from a primary midwife with one or two pregnancy visits to be conducted by a 'back-up' midwife. The midwife will collaborate with obstetricians and other health professionals as necessary. This will be the first RCT of caseload midwifery care in Australia and only the third one conducted anywhere. It is a unique opportunity to provide a rigorous evaluation of a model that is beginning to be implemented widely in Australia. The trial will provide much needed information regarding the outcomes of caseload midwifery including interventions in childbirth, safety, costs, women's satisfaction with care and impact on the midwifery workforce. The study will provide data that will inform clinical practice and guide service providers involved in the organisation of maternity services.