August 21, 2013
Women Who Receive Midwife Care Throughout Their Pregnancy And Birth Have Better Outcomes
Maternity care that involves a midwife as the main care provider leads to better outcomes for most women, according to a systematic review published in The Cochrane Library. Researchers found that women who received continued care throughout pregnancy and birth from a small group of midwives were less likely to give birth pre-term and required fewer interventions during labor and birth than when their care was shared between different obstetricians, GPs and midwives.
In many countries, including the UK and Australia, midwives act as the main providers of care for women throughout pregnancy, labor and birth. In midwife-led care, there is an emphasis on normality, continuity of care and being cared for by a known, trusted midwife during labor. Midwife-led continuity of care is provided in a multi-disciplinary network of consultation and referral with other care providers. This contrasts with medical-led models of care, where an obstetrician or family physician is primarily responsible for care, and with shared-care, where responsibility is shared between different healthcare professionals. There has been some debate about whether the midwife-led model of care is more effective.
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. "Women should be encouraged to ask for this option," said lead researcher Jane Sandall of the Division of Women's Health at King's College London in London, UK, who led an interdisciplinary team of researchers from Sheffield Hallam University, The University of Warwick and National University of Ireland Galway. "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."
Five studies considered the cost of midwife-led compared to shared care. While care provided by midwives was more cost-effective during labour, the results for postnatal care were inconclusive. "There was a lack of consistency in the way that maternity care cost was estimated in the studies, but there seemed to be a trend towards a cost-saving effect of midwife-led care," said Sandall.
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