Postpartum complications in women attended by midwives instead of obstetricians

Abstract

Objective: The aim of this study was to evaluate changes in the frequency of visits to the hospital emergency department due to puerperal complications in low risk postpartum women attended by midwives instead of obstetricians.

Design: A quasi-experimental retrospective study with non-random allocation, comprising two groups: a control group of women attended by obstetricians and an intervention group of women attended by midwives.

Setting: A level 2 hospital in Madrid (España).

Participants: Low risk postpartum women attended at the maternity unit of the Fuenlabrada University Hospital between 2013 and 2015.

Methods: We gathered variables to record the homogeneity of the groups and to assess for confounders and interactions. In the case of women with different behaviours and/or who generated confounders or interactions, a multivariate adjustment with logistic regression was performed. The Homer & Lemeshow goodness-of-fit test for logistic regression was used to determine the validity of the model.

Measurements and findings: The intervention group comprised a total of 1308 women, whereas there were 1313 women in the control group. In the first 40-days postpartum, 33 women in the intervention group (2.5%) attended the hospital emergency department compared to 41 in the control group (3.1%). This difference was not statistically significant (p value 0.354). The relative risk of this decrease was 0.808 (95% CI 0.514; 1.270). The NNT was 167.

Key conclusions and implications for practice: Care by midwives of low risk postpartum women did not lead to a worsening of puerperal complications requiring emergency department care. Furthermore, care by midwives was more effective than obstetrician care with lower emergency department attendance rates. Their qualification and capacity to provide health education were determinant factors.

Keywords: Complications; Health education; Midwife; Postpartum period.