Association between one-to-one midwifery care in the active phase of labour and use of pain relief and birth outcomes: A cohort of nulliparous women

Abstract

Objective: To investigate the association between one-to-one midwifery care and birth outcomes with pain relief as the primary outcome. Secondary outcomes include obstetric and neonatal outcomes, such as mode of birth and Apgar score.

Design: A cohort study of women originally included in a cluster randomised trial.

Setting and participants: The analysis is based on data from The Labour Progression Study (LaPS), a cluster randomised controlled trial (RCT) including 7,277 women, conducted in fourteen obstetric units in Norway, between 2014 and 2017. The participants were nulliparous with a singleton full-term foetus in a cephalic presentation and spontaneous onset of labour. In this cohort, 7,103 women with information about on one-to-one midwifery care were included.

Measurements and findings: Logistic regression analysis show that nulliparous women receiving one-to-one midwifery care in the active phase of labour are less likely to have an epidural analgesia, adjusted OR of 0.81 (95% CI 0.72,0.91), less likely to be given nitrous oxide, adjusted OR of 0.77 (95% CI 0.69,0.85), and they more often received massages, adjusted OR of 1.76 (95% CI 1.47,2.11), compared with women not receiving one-to-one midwifery care. Descriptive analyses show that women receiving one-to-one midwifery care in the active phase of labour are less likely to have a caesarean section (5.8% vs. 7.2%) and they are less likely to have an operative vaginal birth (16.5% vs. 23.7%). No significant differences were observed between the groups in terms of low Apgar scores at five minutes.

Key conclusions: We found that one-to-one midwifery care in the active phase of labour may be associated with birth outcomes, including decreased use of epidural analgesia and a decreased rate of caesarean sections and operative vaginal birth.

Implications for practice: The results of this study could encourage midwives to be present during the active phase of labour to promote physiological birth.

Keywords: Active phase of labour; Birth outcomes; Nulliparous women; One-to-one midwifery care; Pain relief.