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BMC Pregnancy and Childbirth
Published in: BMC Pregnancy and Childbirth 1/2018

Open Access 01-12-2018 | Research article

Effects of midwife-led maternity services on postpartum wellbeing and clinical outcomes in primiparous women under China’s one-child policy

Published in: BMC Pregnancy and Childbirth | Issue 1/2018

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Abstract

Background

The Midwife-led maternity services have been implemented in China in response to the high rates of primiparous women and Caesarean Sections (CS) which may be related to China’s one-child policy. However, few studies in China have been reported on the effectiveness of Midwife-led Care at Delivery (MCD) and the Continuity of Midwife-led Care (CMC) on postpartum wellbeing and other clinical outcomes. Therefore, evidence-based clinical validation is needed to develop an optimal maternity service for childbearing women in China.

Methods

A concurrent cohort study design was conducted with 1730 pregnant women recruited from 9 hospitals in Shanghai. Among the 1730 participants at baseline, 1568 participants completed the follow-up questionnaire, with a follow-up rate of 90.6%.

Results

Compared with the routine Obstetrician-led Maternity Care (OMC), Midwife-led Care at Delivery (MCD) was associated with CS rate (OR were 0.16; 95%CI: 0.11 to 0.25) and a higher total score of postpartum wellbeing (βwere 2.70; 95%CI: 0.70 to 4.70) when adjusting for the baseline differences and other confounders during delivery or postpartum period. Moreover, continuity of Midwife-led Care (CMC) was associated with CS rate (OR were 0.30; 95%CI: 0.23 to 0.41), as well as increased rate of breastfeeding within the first 24 h (OR were 2.49; 95% CI: 1.47 to 4.23), higher postpartum satisfaction (β = 4.52; 95% CI: 1.60 to 12.68), lower anxiety (βwere 0.66; 95% CI: 0.16 to 1.17), increased self-control (βwere 0.39; 95% CI: 0.02 to 0.76) and a higher total score of postpartum wellbeing (βwere 3.14; 95% CI: 1.54 to 4.75).

Conclusion

CMC is the optimal service for low-risk primiparous women under China’s one-child policy, and is worthwhile for a general implementation across China.
Literature
1.
Koblinsky M, Matthews Z, Hussein J, Lancet Maternal Survival Series steering group. Going to scale with professional skilled care. Lancet. 2006;368(9544):1377–86.CrossRefPubMed
2.
3.
4.
Hodnett ED. Continuity of Care Givers for Care During Pregnancy and Childbirth. The Cochrane Library.Update Software, 2001;Oxford Issue 3.
5.
Pascali-Bonaro D, Kroeqer M. Continuous female companionship during childbirth: a crucial resource in times of stress or calm. J Midwifery Womens Health. 2004;49(4 Suppl 1):19–27.CrossRefPubMed
6.
Cooke HM, Waters DL, Dyer K, Picone D. Development of a best practice model of midwife-led antenatal care. Aust Midwifery. 2004;17:21–5.CrossRef
7.
Bick D. Enhancing safety in the maternity services: a greater role for midwife-led care? Midwifery. 2009;25:1–2.CrossRefPubMed
8.
Spiby H, Munro J. The development and peer review of evidence based guidelines to support midwifery led care in labour. Midwifery. 2009;25:3–171.
9.
Harvey S, Jarrell J, Brant R, Staiton C, Rach DA. Randomized controlled trial of nurse-midwifery care. Birth. 1996;23:128–35.CrossRefPubMed
10.
Homer CS, Davis GK, Brodie PM, Chapman MG. Collaboration in maternity care: a randomised controlled trial comparing community based continuity of care with standard hospital care. BJOG. 2001;108:16–22.PubMed
11.
Hodnett ED, Fredericks S, Weston J. Support during pregnancy for women at increased risk of low birthweight babies. Cochrane Database Syst Rev. 2010;16:CD000198.
12.
13.
Schmied V, Beake S, Sheehan A, McCourt C, Dykes F. A meta-synthesis of women's perceptions and experiences of breastfeeding support. JBI Libr of Syst Rev. 2009;7(14):583–614.
14.
McCourt C, Stevens T. Relationship and Reciprocity in Caseload Midwifery. In: Deery R, Hunter B, editors. Emotions in midwifery and reproduction. Basingstoke, Hants: Palgrave Macmillan; 2008. And on support for breastfeeding.
15.
Ufang G, Padmadas SS, Fengmin Z, Brown JJ, Stones RW. Delivery settings and caesarean section rates in China. Bull World Health Organ. 2007;85(10):755–62.CrossRef
16.
Tang S, Li X, Wu Z. Rising cesarean delivery rate in primiparous women in urban China: evidence from three nationwide household health surveys. Am J Obstet Gynecol. 2006;195(6):1527–32.CrossRefPubMed
17.
Klemetti R, Che X, Gao Y, Raven J, Wu Z, Tang S, Hemminki E. Cesarean section delivery among primiparous women in rural China: an emerging epidemic. Am J Obstet Gynecol. 2010;202(1):65 e61–6.CrossRef
18.
19.
20.
Gu CY, Zhang Z, Ding Y. Chinese midwives’ experience of providing continuity of care to labouring women. Midwifery. 2011;27:243–9.CrossRefPubMed
21.
Li C, Zhang L, Ye L, Yang Q, Zhang C, Wan Y (Eds.),. The Call of Life: a Strategic Action and Prospect for a Safe Motherhood Initiative. The Department of Public Health and the Maternity and Child Welfare of the State Public Health Ministry, The United Nations Children’s Fund , 2003;The Women, Children Office of the State Council.
22.
Mander R, Cheung NF. Issues arising in the planning of a cross-cultural research project in China. Clin Eff Nurs. 2006;9:212–20.CrossRef
23.
Cheung NF, Mander R, Wang X, Zhang L. Views of Chinese women and health professionals about midwife-led care in China. Midwifery. 2011;27:842–7.CrossRefPubMed
24.
Homer CS, Davis GK, Cooke M, Barclay LM. Women’s experiences of continuity of midwifery care in a randomised controlled trial in Australia. Midwifery. 2002;18(2):102–12.CrossRefPubMed
25.
Fazio AF. A concurrent validational study of the MCH general well-being schedule. Vital Health Statistics 2. 1977;(73):1-53.
26.
Duan JH. The application of General Well-Being Schedule in university students. Chin J Clin Psych. 1996;4:56–7. In Chinese
27.
28.
Jackson DJ, Lang JM, Swartz WH, Nguyen U. Outcomes, safety, and resource utilization in a collaborative care birth center program compared with traditional physician-based perinatal care. Am J Public Health. 2003;93:999–1006.CrossRefPubMedPubMedCentral
29.
Wang Z, Sun W, Zhou H. Midwife-led care model for reducing caesarean rate: A novel concept for worldwide birth units where standard obstetric care still dominates. J Med Hypotheses Ideas. 2012;6:28–31.CrossRef
30.
31.
Ward KN, Byrne JP. A critical review of the impact of continuing breastfeeding education provided to nurses and midwives. J Hum Lact. 2011;27(4):381–93.CrossRefPubMed
32.
World Health Organisation. Evidence for the ten steps to successful breastfeeding. Geneva: World Health Organisation; 1998.
33.
Bernaix LW. Nurses’attitudes, subjective norms, and behavioral intentions toward support of breastfeeding mothers. J Hum Lac. 2000;16(3):201–9.CrossRef
34.
Dillaway HE, Douma ME. Are pediatric offices supportive of breastfeeding? Discrepancies between mothers’ and healthcare professionals’ reports. Clin Pediatr (Phila). 2004;43(5):417–30.CrossRef
35.
Hailes J, Wellard S. Support for breastfeeding in the first postpartum month: perceptions of breastfeeding women. Breastfeed Rev. 2000;8(3):5–9.PubMed
36.
Smale M, Renfrew MJ, Marshall JL, Spiby H. Turning policy into practice: more difficult than it seems. The case of breastfeeding education. Matern Child Nutr. 2006;2(2):103–13.CrossRefPubMedPubMedCentral
37.
Shields N, Turnbull D, Reid M, Smith LN. Satisfaction with midwife managed care in different time periods: a randomised controlled trial of 1299 women. Midwifery. 1998;14:85–93.CrossRefPubMed
38.
Villar J, Carroli G, Khan-Neelofur D, Piaggio G, Gülmezoglu M. Patterns of routine antenatal care for low-risk pregnancy. Cochrane Database Syst Rev. 2001;(4):CD000934.
39.
Cheung NF, Mander R, Wang X, Fu W, Zhou H, Zhang L. Clinical outcomes of the first midwife-led normal birth unit in China: a retrospective cohort study. Midwifery. 2011;27:582–7.CrossRefPubMed
40.
Parratt J, Fahy K. Including the non rationalis sensible midwifery. Woman Birth. 2008;21:37–42.CrossRef
41.
Homer CS, Passant L, Kildea S, Bordie PM. The development of national competency standards for the midwife in Australia. Midwifery. 2007;23:350–60.CrossRefPubMed
42.
Homer CS, Passant L, Brodie PM, Thorogood C. The role of the midwife in Australia: views of women and midwives. Midwifery. 2009;256:673–81.CrossRef
43.
Hunter B, Berg M, Lundgren I, Olafsdottir OA, Kirkham M. Relationships: the hidden threads in the tapestry of maternity care. Midwifery. 2008;24:132–7.CrossRefPubMed
44.
45.
Hildingsson I, Radestad I. Swedish women’s satisfaction with medical and emotional aspects of antenatal care. J Adv Nurs. 2005;52:239–49.CrossRefPubMed
46.
Halldorsdottir S, Karlsdottir S. Empowerment or discouragement: women′s experience of caring and uncaring encounters during childbirth. 1996;4:361-79.
47.
Gibbins J, Thomson AM. Women’s expectations and experiences of childbirth. Midwifery. 2001;17(4):302–13.CrossRefPubMed
Metadata
Title
Effects of midwife-led maternity services on postpartum wellbeing and clinical outcomes in primiparous women under China’s one-child policy
Publication date
01-12-2018
Published in
BMC Pregnancy and Childbirth / Issue 1/2018
Electronic ISSN: 1471-2393
DOI
https://doi.org/10.1186/s12884-018-1969-9

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