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NICE updates guidance on ‘team midwifery’ in childbirth

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National guidance on the care of healthy women and their babies during childbirth has now been updated in favour of more midwife-led provision.

The National Institute for Health and Care Excellence made the change to its guidance on intrapartum care for healthy women and babies, after new evidence emerged on midwife-led continuity models of care.

As reported by Nursing Times, a proposal to change the guidance was consulted on earlier this year, from 8 August until 6 September.

Following the consultation, which was welcomed by the Royal College of Midwives, NICE has now backed team midwifery – where a number of midwives lead in the planning, organisation and delivery of care given from initial booking to the postnatal period.

In contrast, the old version of the guidance recommended against the use of team midwifery based on a review of evidence by the original guideline development group that developed it in 2007.

It found that team midwifery was associated with a higher rate of perinatal mortality than other care models, leading the group to recommend that team midwifery should not be offered.

The section of the guideline on such care models was not reviewed directly during a subsequent update in 2014.

But during the consultation process for the update, stakeholders highlighted a Cochrane review on midwife-led continuity models, which was “inconsistent” with the NICE recommendations.

The Cochrane review – which assessed data from 15 trials, involving 17,674 mothers and babies – did not find any differences in outcomes between team midwifery and other models of care.

As a result of looking at the Cochrane evidence plus further analysis, NICE said it wanted to delete the line that recommended against the use of team midwifery.

“Evidence reviewed by the update committee demonstrated midwifery-led continuity of care was no less effective than comparator models of care; and there was no evidence to suggest it led to increased risks to the mother and baby,” said NICE.

“The committee acknowledged that removing this recommendation would allow greater access to different models of midwife-led continuity of care,” it added.

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