Women who have a midwife as their main carer throughout pregnancy and birth are around 23% less likely to have a premature baby than women whose care is shared between different obstetricians, GPs and midwives, a new systematic review published by The Cochrane Library has found.
Midwife-led continuity of care – in which a pregnant woman sees the same midwife during pregnancy and labour – is also associated with a lower risk of fetal loss before 24 weeks’ gestation and reduced likelihood of labour interventions such as episiotomies (a surgical cut) or use of forceps.
The latest Cochrane review, based on a systematic review of 13 trials involving 16,242 women, concluded that most women, unless they have significant risk factors, should have the option of midwife-led continuity of care.
“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 concluded.
“The majority of included studies reported a higher rate of maternal satisfaction in the midwifery-led continuity care model. Similarly, there was a trend towards a cost-saving effect for midwife-led continuity care compared to other care models.”
Hannah Dahlen, Professor of Midwifery at University of Western Sydney, said the most significant finding was association between one-on-one midwife care and a significant reduction in the risk of preterm birth.
“Preterm birth is the major cause of early death and major disability for babies. So that’s a stunning outcome,” she said.
“If midwifery care was a tablet you could get at a pharmacy, the companies would be millionaires because everyone would take it.”
Professor Dahlen said that one-on-one care with a familiar midwife often reduces stress and anxiety for pregnant women.
“It’s the top level of scientific evidence that says women cared for by midwives they know have enormous advantages and no disadvantages. There are fewer babies dying, there are fewer things going wrong in labour.”
Some Australian hospitals offer midwifery-led continuity of care for pregnant women but demand for such programs often outstrips the number of places available.
Professor Dahlen said around 80% of pregnant New Zealand women have midwife led continuity of care but in Australia the figure is thought to be between 3 - 5%.
Sally Tracy, Professor in Midwifery at the University of Sydney, and conjoint Professor, School of Women’s and Children’s Health, Faculty of Medicine, UNSW, Midwifery and Women’s Health Research Unit, Royal Hospital for Women, said there was a perception that one-on-one midwife led care of pregnant women cost the health system more.
“But in fact, by the end of it, it costs less because of an accumulation of little things: less pain relief, fewer inductions, and women don’t stay as long in hospital,” she said.
Alec Welsh, Professor and Head of Maternal Fetal Medicine at the University of New South Wales and director of the Australian Centre for Perinatal Science said “you do see good continuity of care in private obstetrician practice as well.”
“But certainly the midwife-led models are associated with decreases in use of epidurals and decreased rates of intervention,” he said.
Hospitals and area health services should not view one-on-one midwife care as an expensive, boutique service and pregnant women should be made aware of the benefits of such schemes, he said.
“We need to get education out there that paying a lot of money for care doesn’t necessarily mean you will get the outcome you want.”
Andrew Bisits, Associate Professor (Conjoint), School of Women’s and Children’s Health at University of New South Wales and Medical Co-director of Maternity at the Royal Hospital for Women, Randwick, said that “at a policy level, more should be done to set up systems of care like this.”
“They are as safe as standard models of care and lead to benefits in the right direction and probably even more than this review even suggests,” he said.