Improving Maternal and Neonatal Health by a Midwife-led Continuity Model of Care - An Observational Study in One Governmental Hospital in Palestine.
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2019-04-16Metadata
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Mortensen B, Lieng MLi, Diep MT, Lukasse M, Atieb, Fosse E. Improving Maternal and Neonatal Health by a Midwife-led Continuity Model of Care - An Observational Study in One Governmental Hospital in Palestine.. EClinicalMedicine. 2019 http://dx.doi.org/10.1016/j.eclinm.2019.04.003Abstract
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.
Publisher
ElsevierThe Lancet
Series
EClinicalMedicine;Volume 10, April 2019Journal
EClinicalMedicine
Except where otherwise noted, this item's license is described as © 2019 Published by Elsevier Ltd. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
Creative Commons-lisensen er mer spesifikt Attribution-NonCommercial-NoDerivatives 4.0 International (CC BY-NC-ND 4.0).