Midwife led care delivers best outcomes, Cochrane review finds

Women whose maternity care is provided primarily by midwives appear to have better outcomes than those who receive their care primarily from doctors or from doctors collaborating with midwives, a Cochrane review has found.1

In the review, Jane Sandall, of the Division of Women’s Health at King’s College London, London, United Kingdom, and colleagues, examined 13 studies involving 16 242 women comparing outcomes of care delivered by a midwife led continuity model of care with that delivered by a doctor led or a shared model of care in which both doctors and midwives provide care.

They found that women who were randomised to care delivered under a midwife led model were less likely to undergo spinal or epidural regional analgesia (average risk ratio 0.83, 95% confidence interval 0.76 to 0.90, 13 trials, n = 15 982, Tau² = 0.01, I² = 48%), to have vaginal birth with instrumentation with forceps or vacuum (average risk ratio 0.88, 95% 0.81 to 0.96, 12 trials, n = 15 809), or to give birth prematurely (average risk ratio 0.77, 95% 0.62 to 0.94, seven trials, n = 11 546, Tau² = 0.03, I² = 42%).

Women who had been randomised to the midwife led model of care were also more likely to experience a spontaneous vaginal birth (average risk ratio 1.05, 95% 1.03 to 1.08, 11 trials, n = 14 995).

The researchers found that there were no statistically significant differences between the groups for caesarean birth (average risk ratio 0.93, 95% 0.84 to 1.02, 13 trials, n = 15 982), overall fetal loss, or neonatal death (average risk ratio 0.84, 95% 0.71 to 1.00, 12 trials, n = 15 869).

“Overall, we did not find any increased likelihood for any adverse outcome for women or their infants associated with having been randomised to a midwife led continuity model of care,” the researchers wrote.

They concluded, “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.”