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Midwife-led care ‘leads to increase in natural births’

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A pioneering midwife-led approach to maternity care has led to a significant increase in natural births in Southampton, according to researchers.

Since 2010, pregnant women at the city’s Princess Anne Hospital who have previously undergone caesarean sections are seen by midwives and not, as is standard practice in most units, obstetricians.

Dr Helen White, a midwifery lecturer at the University of Manchester, has reviewed the care and outcomes of 405 women who gave birth after previously having a caesarean.

“This finding is important for providing evidence that midwives are best-placed to promote vaginal birth”

Helen White

The study, published in the journal Birth, showed 209 gave birth in 2008 when antenatal care was still led by obstetricians and 196 in 2011 after the hospital had moved to midwife-led care.

The number of women who intended to give birth naturally – known as vaginal birth after caesarean (VBAC) – was 90% in the midwife-led group, with 61% going on to achieve it. This compared to 77% and 47%, respectively, under obstetricians.

Dr White, who carried out the research as part of her doctorate with the University of Southampton, said: “Where it can be achieved safely, vaginal birth is preferable, but there’s a real issue with women who have had a caesarean once opting for the same again.”

“There aren’t many initiatives out there to break this cycle, so this finding is important for providing evidence that midwives are best-placed to promote vaginal birth,” she said.

“There were few differences between the two groups of women we studied, so the main variance was the professional responsible for their care,” said Dr White.

She added: “We are not proposing that women should reject caesarean birth when they are advised to do so, but suggest that midwives are important figures in promoting VBAC in suitable women.”

Dr Jane Rogers, a consultant midwife at the Princess Anne Hospital, said University Hospital Southampton NHS Foundation Trust had “broken new ground” with its approach.

“We are very proud of how well our midwives and the mothers have approached this and of our outstanding success in terms of numbers of women achieving a successful vaginal birth,” she said.

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