Study shows midwife-led care leads to better outcomes
Posted on 21/08/2013
Maternity care that involves a midwife as the main care provider leads to better outcomes for most women, according to a systematic review led by King’s researchers and 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.
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, who led an interdisciplinary team of researchers from King’s, Sheffield Hallam University, The University of Warwick and National University of Ireland Galway.
The current NHS mandate states that ‘every woman has a named midwife who is responsible for ensuring she has personalised, one-to-one care throughout pregnancy, childbirth and during the postnatal period, including additional support for those who have a maternal health concern’. This model of care is very popular with women but the national CQC survey of women’s experiences of maternity care in England in 2010 found that 43 per cent of women did not see the same midwife every time or almost every time during pregnancy, and 75 per cent of women had not met any of the staff who cared for them during their labour and birth beforehand.
'This review pulls together the most comprehensive evidence to date on midwife-led continuity models of care and shows that this approach leads to better outcomes for women and their babies,' said Professor Sandall.
'We need to carry out further research to understand better the reasons why, and how these outcomes are achieved. For example, whether it is the model of care itself where midwives are in a position to pick up problems and get the right specialist input as early as possible, or whether a relationship where a woman knows and trusts her midwife leads to a better outcome. But the evidence that midwife-led care leads to better outcomes is clear.
'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.
Notes for editors
Read the review.
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