Researchers have found that mothers who have a midwife as the main care provider throughout pregnancy, as opposed to multidisciplinary care, are less likely to give birth pre-term and need fewer obstetric interventions during childbirth.
The study, published in The Cochrane Library, reviewed data from 13 trials involving 16,242 women. Eight of the trials included women who were at low risk of experiencing complications during labor, while five trials included women at high risk of complications.
Researchers from the UK and Ireland analyzed the outcome of both mothers and babies when midwives were the main providers of care, compared with medical-led (family doctors or physicians) or shared-care models between different obstetricians, doctors and midwives.
Results of the review showed that when midwives were the main care provider throughout the whole pregnancy, mothers:
- Were less likely to lose their babies before 24 weeks
- Were less likely to give birth before 37 weeks
- Had fewer epidurals
- Had fewer assisted births
- Had fewer episiotomies (surgical incision to reduce risk of tearing).
Overall, women who received midwife-only care were generally happier. Additionally, they were no more likely to have a caesarean birth, but were likely to be in labor for half an hour longer compared with women who had medical-led and shared care.
The study authors say that based on their findings, all women should be offered midwife-led care throughout pregnancy, unless they have serious medical complications.
Jane Sandall of the women's health division at Kings College London and lead author of the study, says "women should be encouraged to ask for this option" of midwife-led care, adding:
"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."
The researchers found five studies that also looked at the cost of midwife-led care versus shared-care. They say that midwife care was more cost-effective during labor and that the cost-effectiveness of postnatal care was inconclusive.
Jane Sandall says: "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 study authors add that further research needs to pay particular attention to outcomes that have been under-researched but that are causes of morbidity - "such as postpartum depression, urinary and fecal incontinence, duration of caesarean incision pain, pain during intercourse, prolonged perineal pain and birth injury (to the baby)."
Other studies have also reported the benefits of nurse-led care in obstetrics. A study by researchers at the World Health Organization, published in The Lancet in 2011, found that trained midwives and nurses could provide early medical abortion as safely and effectively as doctors, therefore expanding women's access to safe abortion services.
A recent report from the ACNM (American College of Nurse-Midwives) says that pregnant women cared for by certified nurse-midwives enjoy numerous benefits - including lower rates of cesarean birth, reduced rates of third- and fourth-degree perineal tears, and higher rates of breastfeeding.