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Review helps to shape future of midwifery

Summary

By evaluating the effectiveness of midwife-led care Professor Hora Soltani, with colleagues from four other universities, has helped to shape policy improvements that promote access to midwifery care for low-risk women nationally and internationally. The Cochrane review provides evidence to support safe and effective maternity care. The review was recognised by the Department of Health and informs guidelines on childbirth. Internationally, the research has informed reviews of maternity services in the USA and Brazil, and it has influenced policy change in Australia.

Our research

Professor Soltani at Sheffield Hallam University and colleagues at four other universities - Warwick University, Kings College- London, National University of Ireland and Montréal University - conducted an international collaborative Cochrane review which showed explicit benefits for midwife-led maternity care compared with other types of care.

The original review, which looked at 13 randomised controlled trials, comprising over 12,000 women, found that those with midwife-led care were less likely to have interventions such as epidurals, episiotomy and instrumental birth. Women were also happier with their care, were more likely to have a known carer during birth and had fewer foetal losses before 24 weeks of pregnancy, compared with those in other models, such as doctor-led care.

In 2013, two additional trials of more than 16,000 women, updated the review and showed additional benefits in reducing the risk of premature birth in the midwife-led care model.

The impact

Due to the interdisciplinary nature of the review and its global relevance, the review has had a broad audience worldwide and significant media attention, featuring in journals and at conferences. Soltani has presented the work at several events in the UK, Iran, Lebanon and Indonesia. The review has been selected for the World Health Organisation - Reproductive Health Library providing a summary of its global research and practice implications, available on their website.

Within the UK, findings from the work have influenced national policy, including the Department of Health policy paper outlining its UK-wide vision for midwives' contribution (Midwifery 2020: Delivering Expectations (2010)).

Internationally, the research has informed a commissioned report by the US Institute of Medicine which has produced recommendations for transforming the safety and quality of midwifery practice. It has also helped women's rights activists to support their case against the Brazilian Medical Council which has released resolutions prohibiting women from having midwives as their carer during childbirth; this has informed subsequent plans for the redesign of maternity services. In Australia it has provided evidence for a change in healthcare policy giving all women better access to midwife-led care.

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