Midwife-led births 'safer', finds major study review
Women are less likely to need an epidural, forceps or ventouse delivery if midwives lead their care, according to researchers.
They found women were also less likely to experience premature birth compared to other types of care, including that led by GPs or consultants.
The systematic review, published by the well-respected Cochrane Library, analysed data involving 16,242 women from 13 studies carried out in the UK, Australia, Canada, Ireland and New Zealand.
The findings confirm previous research that midwife-led care results in fewer interventions for women.
The analysts found women were 13% less likely to need an epidural, 16% less likely to need an episiotomy (surgical incision to reduce the risk of a tear) and 12% less likely to need a forceps or ventouse delivery if midwives oversaw the birth.
Women were more likely to give birth naturally but did have slightly longer labours of an extra 30 minutes on average.
Those cared for by a midwife in pregnancy were also less likely to lose the baby before 24 weeks gestation, although there was no difference in pregnancies over 24 weeks.
The experts said: “Midwife-led continuity of care was associated with several benefits for mothers and babies, and had no identified adverse effects compared with models of medical-led care and shared care.
“The main benefits were a reduction in the use of epidurals, with fewer episiotomies or instrumental births.
“Women’s chances of being cared for in labour by a midwife she had got to know, and having a spontaneous vaginal birth were also increased.
“There was no difference in the number of Caesarean births.”
The team said women with high-risk pregnancies should still have the chance to consult specialist doctors and there should be clear guidance for midwives to refer women to other professionals.
“The review concludes that most women should be offered midwife-led continuity models of care, although caution should be exercised in applying this advice to women with substantial medical or obstetric complications,” they wrote.
The research included experts from the School of Nursing and Midwifery at the National University of Ireland in Galway, Sheffield Hallam University and the University of Warwick.
Professor Declan Devane, from the National University of Ireland, said: “This work has important policy implications and provides high quality evidence of the benefits for women and their infants of midwife-led models of care supported by appropriate multi-professional referral.”
A statement from the Royal College of Midwives (RCM) said: “This is a very important and welcome review which adds to a growing body of clinical evidence that childbirth outcomes for women are significantly influenced by the type of maternity services they receive.
“This study specifically focuses on midwife-led care and an emphasis on continuity of care (having the same midwife or a midwife known to them).
“This research shows that having the same midwife provides significant benefits for women who have a medium or low risk during their pregnancy.
“Unfortunately, we know from surveys of maternity care, and anecdotally from women, that many women sadly do not experience such basic care.
“In the recent National Federation of Women’s Institutes and National Childbirth Trust (NCT) survey, 60% of women wanted more support with postnatal care immediately after giving birth, and 20% of women did not see a midwife as often as they needed after giving birth.”
Other research has shown that 12% of women were left alone during labour at a time when it worried them.
The statement added: “The writing is on the wall: this research shows that midwife-led care is what mothers and babies need and deserve.”
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