Abstract：
BACKGROUND: Research has shown caseload midwifery to increase the chance of vaginal birth, but this may not be the case in settings with high vaginal birth rates in standard care. This study investigated the association between caseload midwifery and birth mode, labor interventions, and maternal and neonatal outcomes at a large obstetric unit in Denmark.
METHODS: Cohort study including medical records on live, singleton births fr om June 2018 until February 2022. Exposure was caseload midwifery care compared with standard midwifery care. The primary outcome was birth mode, and secondary outcomes were other outcomes of labor. Adjusted risk ratios (aRR) with 95% confidence intervals (CI) were estimated by log-binomial regression.
RESULTS: Among 16,110 pregnancies, 3162 pregnancies (19.6%) received caseload midwifery care. Caseload midwifery was associated with fewer planned cesareans (aRR 0.63 [95% CI 0.54-0.74]) and emergency cesareans (aRR 0.86 [95% CI 0.75-0.95]). No differences in labor induction, use of epidural analgesia, oxytocin augmentation, or anal sphincter tears were observed. Caseload midwifery performed more amniotomies (aRR 1.14 [95% CI 1.02-1.27]) and tended to perform more episiotomies (aRR 1.19 [95% CI 0.96-1.48]). Postpartum hemorrhage (aRR 0.90 [95% CI 0.82-0.99]) and low Apgar score were less likely (aRR 0.54 [95% CI 0.37-0.77]), and early discharge more likely (aRR 1.22 [95% CI 1.17-1.28]) in caseload midwifery.
CONCLUSIONS: In caseload midwifery care, a higher vaginal birth rate was observed with no increase in adverse outcomes, mainly due to a lower likelihood of planned cesarean. Also, fewer children were born with low Apgar scores.
METHODS: Cohort study including medical records on live, singleton births fr om June 2018 until February 2022. Exposure was caseload midwifery care compared with standard midwifery care. The primary outcome was birth mode, and secondary outcomes were other outcomes of labor. Adjusted risk ratios (aRR) with 95% confidence intervals (CI) were estimated by log-binomial regression.
RESULTS: Among 16,110 pregnancies, 3162 pregnancies (19.6%) received caseload midwifery care. Caseload midwifery was associated with fewer planned cesareans (aRR 0.63 [95% CI 0.54-0.74]) and emergency cesareans (aRR 0.86 [95% CI 0.75-0.95]). No differences in labor induction, use of epidural analgesia, oxytocin augmentation, or anal sphincter tears were observed. Caseload midwifery performed more amniotomies (aRR 1.14 [95% CI 1.02-1.27]) and tended to perform more episiotomies (aRR 1.19 [95% CI 0.96-1.48]). Postpartum hemorrhage (aRR 0.90 [95% CI 0.82-0.99]) and low Apgar score were less likely (aRR 0.54 [95% CI 0.37-0.77]), and early discharge more likely (aRR 1.22 [95% CI 1.17-1.28]) in caseload midwifery.
CONCLUSIONS: In caseload midwifery care, a higher vaginal birth rate was observed with no increase in adverse outcomes, mainly due to a lower likelihood of planned cesarean. Also, fewer children were born with low Apgar scores.
摘要：
背景：研究表明，病例助产会增加阴道分娩的机会，但在标准护理中阴道分娩率高的情况下可能并非如此。这项研究调查了病例助产与分娩方式之间的关系，劳动干预，以及丹麦一家大型产科病房的孕产妇和新生儿结局。
方法：队列研究，包括现场医疗记录，单身出生从2018年6月至2022年2月。与标准助产护理相比，暴露是个案助产护理。主要结果是出生模式，次要结局是其他分娩结局。通过对数二项回归估计具有95％置信区间（CI）的调整风险比（aRR）。
结果：在16,110例怀孕中，3162例孕妇(19.6%)接受了个案助产护理。病例助产与较少的计划剖腹产(aRR0.63[95%CI0.54-0.74])和紧急剖腹产(aRR0.86[95%CI0.75-0.95])相关。引产没有差异，使用硬膜外镇痛，催产素增强,或肛门括约肌撕裂被观察到。病例助产进行了更多的羊膜切除术（RR1.14[95%CI1.02-1.27]），倾向于进行更多的外切术（RR1.19[95%CI0.96-1.48]）。产后出血（aRR0.90[95%CI0.82-0.99]）和低Apgar评分的可能性较小（aRR0.54[95%CI0.37-0.77]），和早期出院的可能性更大（RR1.22[95%CI1.17-1.28]）。
结论：在病例助产护理中，观察到较高的阴道分娩率，而不良结局没有增加，主要是由于计划剖宫产的可能性较低。此外，出生时Apgar得分较低的孩子较少。
方法：队列研究，包括现场医疗记录，单身出生从2018年6月至2022年2月。与标准助产护理相比，暴露是个案助产护理。主要结果是出生模式，次要结局是其他分娩结局。通过对数二项回归估计具有95％置信区间（CI）的调整风险比（aRR）。
结果：在16,110例怀孕中，3162例孕妇(19.6%)接受了个案助产护理。病例助产与较少的计划剖腹产(aRR0.63[95%CI0.54-0.74])和紧急剖腹产(aRR0.86[95%CI0.75-0.95])相关。引产没有差异，使用硬膜外镇痛，催产素增强,或肛门括约肌撕裂被观察到。病例助产进行了更多的羊膜切除术（RR1.14[95%CI1.02-1.27]），倾向于进行更多的外切术（RR1.19[95%CI0.96-1.48]）。产后出血（aRR0.90[95%CI0.82-0.99]）和低Apgar评分的可能性较小（aRR0.54[95%CI0.37-0.77]），和早期出院的可能性更大（RR1.22[95%CI1.17-1.28]）。
结论：在病例助产护理中，观察到较高的阴道分娩率，而不良结局没有增加，主要是由于计划剖宫产的可能性较低。此外，出生时Apgar得分较低的孩子较少。
