That is the conclusion reached by a team of researchers that looked at
All published and unpublished trials in which pregnant women are randomly allocated to midwife-led or other models of care during pregnancy, and where care is provided during the ante- and intrapartum period in the midwife-led model.
Since the allocation was random, it means that all of the women were low-risk at the start of pregnancy, and all could have had midwifery care. And those that did have the model of care most associated with midwives had better results than those who were randomly assigned to obstetricians or family physicians.
These trials included over 12,000 women, and found that,
Women who had midwife-led models of care were less likely to experience
- antenatal hospitalisation
- the use of regional analgesia
- and instrumental delivery
and were more likely to experience
- no intrapartum analgesia/anaesthesia
- spontaneous vaginal birth
- to feel in control during labour and childbirth
- attendance at birth by a known midwife
- and initiate breastfeeding
In addition, women who were randomised to receive midwife-led care were less likely to experience fetal loss before 24 weeks’ gestation, and their babies were more likely to have a shorter length of hospital stay. There were no statistically significant differences between groups for overall fetal loss/neonatal death, or fetal loss/neonatal death of at least 24 weeks.
Let me reiterate — these women were randomly assigned to either midwives or obstetricians, so they were not biased by self-selection. There may be a vast difference between the super-crunchy, all-organic, no-vaccinating, cloth-diapering hippie mama who embraces homebirth as the best way to ensure a natural birth, just as she works hard to ensure a natural everything else in her life, and a typical mainstream mom who does not. [And just for the record, I’m not denigrating either choice, and find myself somewhere in the middle, but closer to the “mainstream mama.”] These women did not choose midwives out of some personal preference — they were chosen to have midwives randomly. And fewer of them had a miscarriage or otherwise lost their baby prior to 24 weeks of gestation.
This is in addition to all of the other benefits listed above.
I’ve previously written about the difficulty in studies comparing midwives and doctors, and home-birth and hospital birth, because of different criteria that midwives may have, while doctors accept both low- and high-risk women. I wished out loud for a study which compared identical client profiles of both midwives and doctors to see how they fared under the two different models of care. “Ask and ye shall receive,” I guess.
Let me repeat the authors’ conclusions:
All women should be offered midwife-led models of care and women should be encouraged to ask for this option.
My thanks to Lisa for first blogging about this and bringing it to my attention.
Filed under: studies & stuff Tagged: | baby, birth, C-section, episiotomy, health, hospital birth, midwife, midwifery model of care, midwives, midwives model of care, obstetrician, pregnancy, pregnant