Women without serious medical or obstetric complications should be offered midwife-led care
THURSDAY, Aug. 22 (HealthDay News) -- Unless they have substantial medical or obstetric complications, most women should be offered the midwife-led continuity model of care for the benefits it provides in pregnancy and birth outcomes, according to research published online Aug. 21 in The Cochrane Library.
Jane Sandall, Ph.D., R.N., of King's College London, and colleagues conducted an intervention review of 13 clinical trials involving 16,242 women to compare midwife-led continuity models of care with other models of care for women and their infants during pregnancy and birth.
The researchers found that women who received midwife-led care experienced significant differences in outcomes (expressed as average risk ratio [RR]), including less regional analgesia (0.83), episiotomy (0.84), and instrumental birth (0.88); they were also more likely to have no intrapartum analgesia/anesthesia (1.16), a spontaneous vaginal birth (1.05), and attendance at birth by a known midwife (7.83). These women had a longer mean duration of labor (mean difference in hours, 0.50) and a similar risk of cesarean birth. Women who were randomly assigned to midwife-led care were at reduced risk for preterm birth (average RR, 0.77) and fetal loss before 24 weeks of gestation (average RR, 0.81); no difference was observed in risk of fetal loss or neonatal death at 24 weeks or later or in overall fetal/neonatal death.
"Most women should be offered midwife-led continuity models of care and women should be encouraged to ask for this option, although caution should be exercised in applying this advice to women with substantial medical or obstetric complications," the authors write.
Abstract (http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD004667.pub3/abstract )Full Text (subscription or payment may be required) (http://onlinelibrary.wiley.com/doi/10.1002/14651858.CD004667.pub3/full )