Comparison of midwife-led and obstetrician-led care in Lithuania: A retrospective cohort study.

OBJECTIVE: To compare midwife-led and obstetrician-led care and their relation to caesarean section rates and obstetric and neonatal outcomes in low-risk births. DESIGN: Hospital registry based retrospective cohort study. SETTING: Tertiary-care women's hospital in Kaunas, Lithuania. PARTICIPANTS: A total of 1384 and 1283 low-risk delivering women in 2012 and 2014, respectively. METHODS: The women choose either a midwife as their lead carer (midwife-led group), or an obstetrician-gynaecologist (obstetrician-led group). MAIN OUTCOME MEASURES: The primary outcome was caesarean birth. Secondary outcomes included instrumental vaginal births, amniotomy, augmentation of labour, epidural analgesia, episiotomy, perineal trauma, labour duration, birthweight and Apgar score < 7 at 5 min. RESULTS: The proportion of caesarean births was 4.4% in the midwife-led and 10.7% in the obstetrician-led group (p < 0.001) in 2012, and 5.2% and 11.8% (p < 0.001) in 2014, respectively. Younger maternal age (≤34 years) and midwife-led care was associated with a significantly decreased odds for caesarean section and nulliparity with a significantly increased odds for caesarean birth. Women in the midwife-led group had fewer amniotomies and labour augmentations compared with the obstetrician-led group. Episiotomy, perineal trauma, duration of labour and neonatal outcomes did not differ between the groups. CONCLUSION: Midwife-led care for women with low-risk birth reduced the caesarean section and several medical interventions with no apparent increase in immediate adverse neonatal outcomes compared with obstetrician-led care. IMPLICATIONS FOR PRACTICE: Midwife-led care for low-risk women should be encouraged in countries with health care system where obstetrician-led care births dominates.

Perceived changes in knowledge and confidence of doctors and midwives after the completion of the Standardized Trainings in Obstetrical Emergencies.

BACKGROUND AND OBJECTIVES: There are only few training programs in obstetric emergencies currently in use and only some of them were evaluated with an adequate sample of participants. Therefore, we present the evaluation of the novel Standardized Trainings in Obstetrical Emergencies (STrObE), conducted in Lithuania. The aim of this study was to analyze whether participants' self-reported knowledge and confidence increased after the trainings, and whether the impact of the trainings was long-lasting. MATERIALS AND METHODS: Data was collected across the majority of hospitals providing secondary and tertiary obstetrical care in Lithuania in 2015. A total of 650 obstetricians-gynecologists and midwives attended the trainings; 388 (response rate 59.7%) of them filled in the initial questionnaire before the trainings, 252 (64.9%) immediately after, 160 (41.2%) 6 weeks after, and 160 (41.2%) 6 months after the trainings, which was the final sample for the analyses. Participants used a Likert-type scale to evaluate their knowledge and confidence about management of urgent obstetrical situations: vacuum-assisted vaginal delivery, shoulder dystocia, postpartum hemorrhage, preeclampsia/eclampsia, early preterm labor, and dystocia. We assessed how participants' self-reported knowledge and confidence changed after the trainings (compared to before the trainings) and how long the effect was retained for. RESULTS: The mean score of self-reported knowledge in obstetrical emergencies increased immediately after the trainings comparing to the scores before the trainings (P<0.001) and it did not differ further between the three time points after the trainings (i.e. immediately, 6 weeks, and 6 months; P>0.05). The same pattern was observed for self-reported confidence scores. The increase in self-reported knowledge and confidence after the trainings was stable. Moreover, the self-reported knowledge and confidence gains were greater for those participants with lower work experience, although benefit was seen across all experience levels. CONCLUSIONS: STrObE improved participants' self-reported knowledge and confidence and lasting positive effects were observed for at least 6 months after the initial trainings. Moreover, the trainings were more beneficial for those with lower work experience, although they benefited all the participants.