A systematic review published by the Cochrane Collaboration has found that most women should be offered midwife-led continuity models of care and women should be encouraged to ask for this option. The updated review included 13 trials involving 16,242 women in order to evaluate models of care where midwives provided care throughout pregnancy, during labour and after birth. although it was noted that caution should be exercised in applying this advice to women with substantial medical or obstetric complications, the results were almost wholly positive.
“Women who had midwife-led continuity models of care were less likely to experience regional analgesia (average risk ratio (RR) 0.83, 95% confidence interval (CI) 0.76 to 0.90), episiotomy (average RR 0.84, 95% CI 0.76 to 0.92), and instrumental birth (average RR 0.88, 95% CI 0.81 to 0.96), and were more likely to experience no intrapartum analgesia/anaesthesia (average RR 1.16, 95% CI 1.04 to 1.31), spontaneous vaginal birth (average RR 1.05, 95% CI 1.03 to 1.08), attendance at birth by a known midwife (average RR 7.83, 95% CI 4.15 to 14.80), and a longer mean length of labour (hours) (mean difference (hours) 0.50, 95% CI 0.27 to 0.74). There were no differences between groups for caesarean births (average RR 0.93, 95% CI 0.84 to 1.02).
Women who were randomised to receive midwife-led continuity models of care were less likely to experience preterm birth (average RR 0.77, 95% CI 0.62 to 0.94) and fetal loss before 24 weeks’ gestation (average RR 0.81, 95% CI 0.66 to 0.99), although there were no differences in fetal loss/neonatal death of at least 24 weeks (average RR 1.00, 95% CI 0.67 to 1.51) or in overall fetal/neonatal death (average RR 0.84, 95% CI 0.71 to 1.00).’ (Sandall et al 2013:1).”
The Royal College of Midwives responded to the publication of this review by commenting that:
“This is a very important and welcome review which adds to a growing body of clinical evidence that childbirth outcomes for women are significantly influenced by the type of maternity services they receive. This study specifically focuses on midwife-led care and an emphasis on continuity of care (having the same midwife or a midwife known to them). This research shows that having the same midwife provides significant benefits for women who have a medium or low risk during their pregnancy.
Unfortunately, we know from surveys of maternity care, and anecdotally from women, that many women sadly do not experience such basic care. In the recent NFWI and NCT survey, 60 per cent of women wanted more support with postnatal care immediately after giving birth, and 20 per cent of women did not see a midwife as often as they needed after giving birth. With the Care Quality Commission’s maternity services survey, only 57 per cent of women said they saw the same midwife “most” or “every” time for antenatal check-ups. At some point during labour, 12 per cent of women were left alone at a time when it worried them.”
It is clear that midwife-led care benefits women and babies and it is to be hoped that maternity services can respond to such evidence and offer women a choice of woman-centred, midwife-led models of care.
Sandall J, Soltani H, Gates S et al (2013). Midwife-led continuity models versus other models of care for childbearing women. Cochrane Database of Systematic Reviews, Issue 8.[accessed 27 august 2013].