Midwife-led care

Want to decrease the likelihood that you'll have an episiotomy, an instrumental delivery, or use pain medications (both IV narcotics and epidural/spinal anesthesia) during labor? Want to reduce the need for hospitalization during pregnancy? Want to increase the odds that you'll have a spontaneous vaginal birth, that you will feel in control during labor and birth, that you will know the birth attendant actually present when you go into labor, and that you will initiate breastfeeding? Want to reduce the chance that you will lose your baby during the first 24 weeks of gestation? Want a shorter hospital stay for your baby? Want all these benefits, with no increase in overall fetal or neotatal death rates?

Choose a midwife!

The Cochrane Library just published results from 11 trials, totaling 12,276 women, of women randomly assigned to midwife-led care, versus other forms of care (care with family physicians or obstetricians, or shared between several health care professionals). In other words, these studies were not of women who self-selected midwives to care for them, but of women who were randomly assigned to either group. They found a host of benefits to having a midwife as the primary care provider, with no identified adverse effects.

I haven't yet downloaded the full text of the study, but I assume that the midwife-led care in the trials was entirely or primarily hospital-based. In other words, these benefits apply to the 98-99% of women who choose hospital birth in North America and other industrialized countries, not just to the 1-2% who choose home birth or birth centers.

Here is a "plain language summary" of the Cochrane findings:

Midwife-led versus other models of care for childbearing women

Midwife-led care confers benefits for pregnant women and their babies and is recommended.

In many parts of the world, midwives are the primary providers of care for childbearing women. Elsewhere it may be medical doctors or family physicians who have the main responsibility for care, or the responsibility may be shared. The underpinning philosophy of midwife-led care is normality and being cared for by a known and trusted midwife during labour. There is an emphasis on the natural ability of women to experience birth with minimum intervention. Some models of midwife-led care provide a service through a team of midwives sharing a caseload, often called 'team' midwifery. Another model is 'caseload midwifery', where the aim is to offer greater continuity of caregiver throughout the episode of care. Caseload midwifery aims to ensure that the woman receives all her care from one midwife or her/his practice partner. By contrast, medical-led models of care are where an obstetrician or family physician is primarily responsible for care. In shared-care models, responsibility is shared between different healthcare professionals.

The review of midwife-led care covered midwives providing care antenatally, during labour and postnatally. This was compared with models of medical-led care and shared care, and identified 11 trials, involving 12,276 women. Midwife-led care was associated with several benefits for mothers and babies, and had no identified adverse effects. The main benefits were a reduced risk of losing a baby before 24 weeks. Also during labour, there was a reduced use of regional analgesia, with fewer episiotomies or instrumental births. Midwife-led care also increased the woman's chance of being cared for in labour by a midwife she had got to know. It also increased the chance of a spontaneous vaginal birth and initiation of breastfeeding. In addition, midwife-led care led to more women feeling they were in control during labour. There was no difference in risk of a mother losing her baby after 24 weeks. The review concluded that all women should be offered midwife-led models of care.