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CONFERENCE PROCEEDING
The causal effect of midwifery staffing on maternal and neonatal outcome – Target trial emulation
1
University of Basel, Department Public Health, Basel, Switzerland
2
University College Dublin, School of Nursing- Midwifery- and Health Systems, Belfield, Ireland
3
University of Basel, Department of Mathematics and Computer Science, Basel, Switzerland
Eur J Midwifery 2026;10(Supplement 1):A901
ABSTRACT
BACKGROUND:
Associations between midwifery staffing and quality of care outcomes are well-established. The evidence, however, is based mainly on cross-sectional studies with direct evidence for causal relationships lacking. With the current midwifery workforce shortage, it is critical for policy makers that the evidence is strengthened to support decisions.
OBJECTIVES:
To describe the causal effect of midwifery staffing on rates of spontaneous vaginal births, use of labour pain medication, exclusive breastfeeding at hospital discharge and the healthy newborn.
METHODS:
A target trial emulation was conducted using longitudinal routine hospital data over a period of four years (2019 to 2022). Data were provided by a tertiary hospital in Switzerland with around 2,600 births per year. The causal contrasts were gold-standard midwifery staffing during established labour and birth (1-to-1 care 100% of time) compared to non-gold-standard midwifery staffing (<100% 1-to-1 care). Similarly for the postnatal unit, target midwife-to-patient ratio (1-to-4 mother-baby-dyads) was compared to less than target ratio. Confounders were identified by developing directed acyclic graphs for each outcome individually. Causal inference methodologies (marginal structure models, g-formula) were applied to adjust for confounding.
RESULTS:
During labour and birth, compared to non-gold-standard midwifery staffing (n=5 525, 84%), women receiving gold-standard midwifery staffing (n=1 072, 16%) gave birth vaginally 5.7% [95%-CI 2.3% – 9.0%] more often and requested epidural analgesia 3.9% [95%-CI -6.8% – -0.8%] less often. For the outcomes breastfeeding at hospital discharge and healthy newborn, no effect could be shown.
CONCLUSIONS:
Target trial emulation is a suitable methodology to use routine hospital data. Women receiving gold-standard midwifery staffing experience fewer interventions; however, only 16% of women in our study received one-to-one care continuously throughout established labour and birth.
KEY MESSAGE:
Increasing the numbers of midwives is necessary along with better alignment between care demand and care supply during labour and birth. Poster session 4 (Group B)
Associations between midwifery staffing and quality of care outcomes are well-established. The evidence, however, is based mainly on cross-sectional studies with direct evidence for causal relationships lacking. With the current midwifery workforce shortage, it is critical for policy makers that the evidence is strengthened to support decisions.
OBJECTIVES:
To describe the causal effect of midwifery staffing on rates of spontaneous vaginal births, use of labour pain medication, exclusive breastfeeding at hospital discharge and the healthy newborn.
METHODS:
A target trial emulation was conducted using longitudinal routine hospital data over a period of four years (2019 to 2022). Data were provided by a tertiary hospital in Switzerland with around 2,600 births per year. The causal contrasts were gold-standard midwifery staffing during established labour and birth (1-to-1 care 100% of time) compared to non-gold-standard midwifery staffing (<100% 1-to-1 care). Similarly for the postnatal unit, target midwife-to-patient ratio (1-to-4 mother-baby-dyads) was compared to less than target ratio. Confounders were identified by developing directed acyclic graphs for each outcome individually. Causal inference methodologies (marginal structure models, g-formula) were applied to adjust for confounding.
RESULTS:
During labour and birth, compared to non-gold-standard midwifery staffing (n=5 525, 84%), women receiving gold-standard midwifery staffing (n=1 072, 16%) gave birth vaginally 5.7% [95%-CI 2.3% – 9.0%] more often and requested epidural analgesia 3.9% [95%-CI -6.8% – -0.8%] less often. For the outcomes breastfeeding at hospital discharge and healthy newborn, no effect could be shown.
CONCLUSIONS:
Target trial emulation is a suitable methodology to use routine hospital data. Women receiving gold-standard midwifery staffing experience fewer interventions; however, only 16% of women in our study received one-to-one care continuously throughout established labour and birth.
KEY MESSAGE:
Increasing the numbers of midwives is necessary along with better alignment between care demand and care supply during labour and birth. Poster session 4 (Group B)
| eISSN: | 2585-2906 |
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