Validation of a Midwifery Model in Palestine 2

The Palestinian Midwifery-led Continuity Model's Effect on Mothers' and Babies' Health Outcomes

A midwife-led continuity model of care was implemented in governmental maternal facilities in Palestine. Midwives from the hospitals provided outreaching caseload ante- and postnatal care to women in rural villages clinics and homes. This study investigated if the model had impact on important maternal and neonatal health outcomes. A retrospective cohort design was used.

Study Overview

• Status: Completed
• Conditions: Prenatal Care
• Intervention / Treatment: Other: Midwife led continuity model of care

Detailed Description

Background: A midwife-led continuity model of care was implemented in governmental maternal facilities in Palestine. Midwives from the hospitals provided outreaching caseload ante- and postnatal care to women in rural villages clinics and homes. This study investigated if the model had impact on important maternal and neonatal health outcomes.

Method: A retrospective cohort design was used. Nablus governmental hospital, Rafidia's medical records were reviewed and data extracted involving 2199 women with singleton pregnancies, residing in rural villages, and their new-born babies born between January 2016 and February 2017. Outcomes were limited to the available information in the hospital's birth registry. Important maternal outcomes were postpartum anaemia (Hb <11), mode of delivery and induction of labour. Important outcomes for new-borns were premature delivery < 37 weeks, birth weight < 2500g and 1500g and referral to neonatal intensive care unit. Outcomes were compared between women receiving the midwife-led continuity model of antenatal care and women receiving regular care.

• Study Type: Observational
• Enrollment (Actual): 2199

Contacts and Locations

Study Locations

• Palestinian Territory, occupied
  • West Bank
    • Nablus, West Bank, Palestinian Territory, occupied
      • Palestinian Ministry of Health

Participation Criteria

Eligibility Criteria

• Ages Eligible for Study: 15 years to 44 years (Child, Adult)
• Accepts Healthy Volunteers: No
• Genders Eligible for Study: Female

• Sampling Method: Non-Probability Sample

Study Population

Palestinian women With singleton pregnancies

Description

Inclusion Criteria:

• Women with singleton pregnancies residing in rural areas giving birth at Nablus governmental hospital, Palestine

Exclusion Criteria:

• Multiple pregnancies
• Women residing in urban areas

Study Plan

How is the study designed?

Design Details

• Observational Models: Cohort
• Time Perspectives: Prospective

Number of groups / cohorts

2

Cohorts and Interventions

Group / Cohort	Intervention / Treatment
Midwife led continuity model of care; Women who received antenatal care from midwives from the hospital reaching out to the rural villages	Other: Midwife led continuity model of care; Midwives from the hospitals provided outreaching caseload ante- and postnatal care to women in rural villages clinics and homes
Regular care group; Women who received care from doctors, nurses or midwives employed at primary Health care centres in rural villages

What is the study measuring?

Primary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Emergency Caesarean section rate	Percentage of women undergoing emergency Caesarean section	17 months

Secondary Outcome Measures

Outcome Measure	Measure Description	Time Frame
Premature birth rate	Babies born before 37 weeks gestational age	17 months
Post partum anaemia in the mother	Low Hb Level at discharge from hospital	17 months
Induction of Labour rate	The rate of women in each group who received induction of labour	17 months
Birth weight	Weight immediately post partum: Low (<2500g) Very low (<1500)	17 months
APGAR score 5 minutes post partum	APGAR score	17 months
Referral to neonatal intensive care	Rate of babies that were referred to neonatal intensive care during hospital stay	17 months
Blood transfusion rate post partum	Rate of women receiving blood tranfusion during the hospital stay	17 months

Collaborators and Investigators

• Sponsor: Oslo University Hospital
• Collaborators: University of Oslo
• Investigators: Principal Investigator: Erik Fosse, Phd, Oslo University Hospital

Study record dates

Study Major Dates

• Study Start (Actual): January 1, 2016
• Primary Completion (Actual): February 28, 2017
• Study Completion (Actual): August 30, 2018

Study Registration Dates

• First Submitted: August 7, 2018
• First Submitted That Met QC Criteria: August 17, 2018
• First Posted (Actual): August 21, 2018

Study Record Updates

• Last Update Posted (Actual): February 28, 2019
• Last Update Submitted That Met QC Criteria: February 26, 2019
• Last Verified: February 1, 2019

More Information

Terms related to this study

• Keywords: Midwifery-led continuity of care; Birth complications
• Other Study ID Numbers: Midwif2

Plan for Individual participant data (IPD)

• Plan to Share Individual Participant Data (IPD)?: Undecided
• IPD Plan Description: IPD can be obtained upon approval of the Palestinian Ministry of Health

Drug and device information, study documents

• Studies a U.S. FDA-regulated drug product: No
• Studies a U.S. FDA-regulated device product: No