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Back 17 October 2013

Midwife-led care - best option for childbearing women

A recent study with over 16,000 pregnant women has shown that midwife-led care has several benefits for mothers and babies. It compared midwife-led continuity model versus other models of care for childbearing women. The research was conducted by Jane Sandall with four co-authors, one of them Hora Soltani, chair of the ICM Research Advisory Network. The study, published in the Cochrane library (highest international authority for assessing medical evidence), examined the evidence of 13 trials involving women both at low and increased risk of complications.

Findings showed that women who had received midwife-led continuity model of care experienced less preterm births and fewer medical interventions. Moreover, benefits included a reduction in the use of epidurals, with fewer episiotomies or instrumental births. On the other hand, there was no difference in the number of caesarean births. Women who received midwife-led continuity of care were less likely to lose their baby before 24 weeks’ gestation, although there were no differences in the risk of losing the baby after 24 weeks, or overall. The study had not shown any negative side effects of midwife-led care compared with models of medical-led and shared care. Read the full study here.

Australian obstetricians criticized the study, claiming it is safest for women to be treated by midwives working together with doctors. The President of the Royal Australian and New Zealand College of Obstetricians & Gynaecologists found the review unsurprising and stated there is no reason to shift towards more midwife-led care. However, he called on both professions to collaborate closely, as ”up to 40 percent of women identified as low risk during pregnancy develop complications, so collaboration between midwife and obstetrician provides the best maternity care for all women”. Read the full article here.

Another approach takes Sweden, where midwives oversee nearly all pregnancies, with only one ultrasound and few tests during an entire pregnancy. Despite minimal interventions, Sweden was rated the second-best country in the world to become a mother. According to Swedish midwives and professors in health studies, pregnancy is not an illness and should not be treated as one; doctors need to be called only in case of complications. Professor Marie Berg thinks ‘it’s also an efficient system in terms of cost management. In countries where doctors care for pregnant women, the number of tests and ultrasounds often multiply, which opens the easy way to money’. Read the full article here.

The study published by the Cochrane library concludes that most women should be offered midwife-led continuity models of care, although caution should be exercised in applying this advice to women with substantial medical or obstetric complications. ICM has been promoting autonomous midwives as the most appropriate caregivers for childbearing women for a long time. With the development of core documents ICM strengthens midwifery worldwide and ensures midwives provide high-quality care for women and their newborns.  

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