Pregnant women who are cared for by a small team of midwives have better outcomes than when care is shared between different obstetricians, GPs and midwives, researchers say today.
The Cochrane review, published today, was led by Professor Jane Sandall of King’s College London in London, UK.
Midwives are the main care providers in most pregnancies, labours and births in many countries, including the UK and Australia. Midwife-led care tends to aim for continuity of care within a small group. On the other hand, medical-led models of care involve an obstetrician or family doctor taking the lead.
To investigate which is more effective, Professor Sandall’s team reviewed figures from 13 trials of 16,242 women.
This showed that when midwives were the main care providers, the rate of stillbirth or premature birth was lower, women were happier with their care, the epidural rate was lower, there were fewer assisted births and fewer episiotomies.
"Women should be encouraged to ask for this option," said Professor Sandall. "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."
She calls for all women to be offered midwife-led continuity of care unless they have serious medical or obstetric complications.
The review included five studies looking at the costs of each type of care. This indicated that midwife-led care was more cost-effective during labour, but the results were inconclusive for postnatal care.
Professor Sandall explains: "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."
The findings were welcomed by the UK’s Royal College of Midwives, which said it was a "very important and welcome" review.
Sandall, J. et al. Midwife-led continuity models versus other models of care for childbearing women. Cochrane Database of Systematic Reviews 2013, Issue 8. Art. No.: CD004667. Doi: 10.1002/14651858.CD004667.pub3.
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