COSMOS: Comparing Standard Maternity Care with One to One Midwifery Support (COSMOS): A Randomised Trial
Helen McLachlan, Della Forster, Mary-Ann Davey, Michelle Newton; in collaboration with Lisa Gold, Deakin University; Mary Anne Biro, Monash University; Tanya Farrell and Jeremy Oats, Royal Women’s Hospital; Ulla Waldenström, Karolinska Institute; Leah Albers, University of New Mexico
Continuity of carer in the provision of maternity care has been strongly recommended and encouraged in Victoria and throughout Australia. Many hospitals responded by introducing caseload midwifery, a one to one midwifery model of care in which women are cared for by a primary midwife throughout pregnancy, birth and the early postnatal period. However, this model of care had not been subjected to rigorous evaluation.
The COSMOS trial compared caseload midwifery care with the standard options of care for women at low risk of medical complications at the Royal Women’s Hospital in Melbourne. The trial which recruited over 2,300 women, found that women who were randomly allocated to receive caseload midwifery care (compared with women allocated to standard care), were less likely to have a caesarean birth, more likely to have a normal birth, and less likely to have epidural pain relief during labour. The study also found that babies of women who had caseload midwifery care were less likely to be admitted to the special care nursery or neonatal intensive care. Women allocated to caseload midwifery were also more satisfied with their care during pregnancy, birth, and after the birth in hospital and at home. They also had more positive experiences of labour and birth.
The study is the first randomised controlled trial of caseload midwifery in Australia and only the fourth internationally. It is also the largest study of its kind in the world. The results have assisted policy-makers and maternity services in planning for future models of maternity care in Australia and Internationally.