August 2013 Women Who Receive Midwife Care Throughout Their Pregnancy and Birth Have Better Outcomes

NUI Galway School of Nursing and Midwifery partner with 3 UK universities in research findings on models of maternity care

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 labour 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, labour 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 labour.

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.

The researchers 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. An episiotomy 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.

Researchers from the School of Nursing and Midwifery in NUI Galway joined with Sheffield Hallam University, The University of Warwick to form an interdisciplinary team of researchers led by Jane Sandall of the Division of Women’s Health at King’s College London.

Professor Declan Devane of the School of Nursing and Midwifery at NUI Galway 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. Other countries are using this to inform their maternity care policy and Ireland should do likewise.’

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 wide variation in the way that maternity care costs were estimated in the included studies, but what was there suggested cost-saving effects of midwife-led care,” said Professor Devane.

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