Review of the Impact of a Modern Model of Midwife-Oriented Continuous Care during Pregnancy, Childbirth and After Childbirth on Maternal Consequences
Azam Bagheri1, Dr. Masoomeg Simbar2, Dr. Mansooreh Samimi3, Dr. Fatemeh Nahidi4, Dr. Hamid Alavi Mojdeh5
Introduction: there is a variety of models for providing services during pregnancy, while childbirth and after childbirth. It is obvious that these models are focused on the maximum quality, efficiency and increasing mothers' satisfaction. The health services provision services system in Iran is based on the reinforcement of classification, continuous provision of care and of course eliminating or reducing the additional expenses of treatment. Therefore, a model for providing continuous midwifery services for pregnant women which is based on the purposes of the country's health system was designed and executed and its maternal consequences were compared with the current system.
Research method: this study is a part of the results of an action research which has been conducted at the level of specialized PhD of Reproductive Health. Firstly, by using a qualitative study and a prescriptive pattern of a model of providing team midwife-oriented continuous care during pregnancy, while childbirth and after childbirth was designed. In this model, 5 main themes were considered: continuity of care, caring process based on physiologic delivery, continuous supportive management, continuous education and moral professionalism. In order to execute the model, the clinical trial was used. The sample volume was calculated to be 200 pregnant women (100 in the experimental group and 100 in the control group). For sampling, these pregnant women were firstly evaluated by the central midwife. In case they were willing and there wasn't a risk, they were sent to the continuous care center. In the continuous care center, the continuous care was provided as midwife-oriented and team care and whenever needed, a specialist was used. For each pregnant woman in the sample group, a pregnant woman of the same center was selected as a member of the control group if some of their specifications were the same such as body mass index, age and gravid. The information collection method was a method done through filling out the interview form, questionnaire and check-list which was filled out in various stages from the time of pregnancy to one month after childbirth. Ultimately, information was analyzed by the SPSS21 software.
Results: firstly, 112 persons were registered in the continuous care group and 109 in the control group and finally, 100 of the continuous care group and 104 of the control group gave birth in situations with low risk. According to the results of the study, there was no significant difference in terms of being in a risky pregnancy condition, hospitalization and bleeding during pregnancy (P=0.43). according to the research results, women of the experimental group participated in the preparation for childbirth classes (P<0.001) and had lower average of the number of visits during pregnancy, lower number of ultrasound, higher age of pregnancy at the time of hospitalization and shorter hospitalization (P<0.001). A lower C-Section prevalence (P=0.025), less induction, spontaneous beginning of labor and more physiological delivery (P<0.001) were seen in them. According to the results of the study, in case of midwife-oriented continuous care, the risk of c-section reduced for 46% and risk of induction reduced for 40% and the probability of the spontaneous beginning of labor increased for 67% and the probability of physiological delivery increased from 63% to 95%. In addition, the results showed that there was no significant difference between the two groups in terms of the rate of consuming anesthesia, narcotic consumption, postpartum hemorrhage, curettage, episiotomy, perforation, urinary incontinence, postpartum infection, mastitis and postpartum depression (P>0.05). In addition, all of the mothers lived in the two groups.
Ultimate conclusion: according to the results of this study and by considering the presence of midwives at the first level of providing services of the time of pregnancy at the health centers of the community of the entire country, the midwife-oriented continuous care model can be easily executed during pregnancy, while childbirth and after childbirth at least for pregnant women with low risk and it can improve many of the health indexes such as high rates of c-section with the minimum expenses.