Midwife-led care provides positive results
Tuesday 20 August 2013
Maternity care that involves a midwife as the main care provider leads to better outcomes for most women, according to a team of university researchers.
Hora Soltani, Professor of Maternal and Infant Health at Sheffield Hallam University, is the co-author of a new study that found women who receive continued care throughout pregnancy and birth from a small group of midwives are less likely to give birth prematurely than when their care was shared between different obstetricians, GPs and midwives.
The study, which has today been published in the healthcare-acclaimed Cochrane Library, also found pregnant women required fewer interventions during labour and birth when cared for by midwives.
In many countries, including the UK and Australia, midwives act as the main providers of care for women throughout pregnancy, labour and birth. In midwife-led care, there is an emphasis on normality, a continuity of care and being cared for by a known, trusted midwife throughout the entire pregnancy and following birth.
Midwife-led continuity of care is provided by a team of midwives who are the main care providers, however referral to medical colleagues may occur if there are any deviations from the norm. This contrasts with medical-led models of care, where an obstetrician or family physician is primarily responsible, and with shared-care, where responsibility is shared between different healthcare professionals.
The study, led by King’s College London in collaboration with Sheffield Hallam, the University of Warwick and the National University of Ireland Galway, reviewed data from 13 trials involving a total of 16,242 women. Eight trials included women at low risk of complications and five trials included women at high risk of complications. They looked at outcomes for mothers and babies when midwives were the main providers of care, compared to medical-led or shared care models. When midwives were the main providers of care throughout, women were less likely to give birth before 37 weeks or lose their babies before 24 weeks.
Women were happier with the care they received, had fewer epidurals, fewer assisted births, and fewer episiotomies - a procedure that involves making a surgical incision to reduce the risk of a tear. In addition, women who received midwife-led care were no more likely to have a caesarean birth, but they were in labour for about half an hour longer on average.
Based on these results, the researchers conclude that all women should be offered midwife-led continuity of care unless they have serious medical or obstetric complications.
Professor Soltani, who is based in Sheffield Hallam's Centre for Health and Social Care Research, said: 'It's important to stress that this research is not a comparison between a midwife and a doctor, it's about trying to raise awareness amongst women that they can have confidence in their own abilities to have a normal birth with the help of midwives.
'The perception is that in order to get the highest quality of care, they must be cared for by a senior clinician and that is simply not the case. Midwives provide a sense of normality and by having a midwife they know during pregnancy it allows the mother to feel comfortable and at ease during labour which in turn is much better for the baby.
'Midwife-led care may also be more cost-effective and potentially releases the pressure on consultants who can concentrate on the mothers who require urgent and critical care but this requires further investigation.'
Lead researcher, Jane Sandall of the Division of Women’s Health at King’s College London, said: 'Women should be encouraged to ask for this option. Policymakers in areas of the world where health systems do not provide midwife-led care should consider the importance of midwives in improving maternity care and how financing of midwife-led services can be reviewed to support this.'