Midwife-led care best for babies and moms, researchers say

Midwives could safely lead the care in most pregnancies, say international researchers who compared outcomes for women and their babies.

In midwife-led care, the midwife is the lead professional in planning, organizing and delivery of care throughout pregnancy and delivery. In medical-led models of care, an obstetrician or family physician mainly has those responsibilities, with midwives sometimes part of a team but not the leader.

In Wednesday's issue of the Cochrane Database of Systematic Reviews, Jane Sandall of King's College in London and her co-authors compared midwife-led and other models of care from 13 trials involving more than 16,000 women with both low and increased risk of complications.

When midwives were the main providers of care, women were less likely to give birth before 37 weeks.

Women also had fewer epidurals, fewer assisted births such as with forceps and fewer episiotomies — surgical incisions to reduce the risk of a tear. Most studies also reported higher levels of maternal satisfaction in midwife-led models.

"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," Sandall's team concluded.

Women who received midwife-led care were no more likely to have a caesarean birth, but they were in labour for about half an hour longer on average.

Midwife Rebecca Carson of Guelph, Ont., said the findings on fewer interventions make sense given how midwives view birth as normal.

"There's more time in the visit to really address their concerns," Carson said. "So my expectation is we would really care for the whole person, address problems early, refer problems early and that allows women to be healthy."

Megan Prier was a client of Carson's for the birth of her second child, Ayla, seven weeks ago.

"She was born quickly and easily. I mean sort of," Prier said with a laugh.

Prier said her two midwives were perfect for her family. 

"They were my friends," Prier said. "They cared about me and I knew that they cared about me and nothing was ever rushed."

Dr. Jennifer Blake, CEO of the Society of Obstetricians and Gynecologists of Canada, said women are encouraged to select a provider with whom they're most comfortable.

"As a society, we looked at this and felt very reassured that the way we do things in Canada provides women with their choice of providers really is supported by the evidence," Blake said.

She noted the study included only one small study from Canada.

"When we looked at all the major outcomes, things that we worry about like caesarean-section rate and induction rate, neonatal outcome, all of those were very, very similar," Blake said. She suspects that's because C-section rates are mostly driven by patient characteristics such as maternal age and obstetrical risk situation rather than the provider.

Nearly 70 per cent of women were attended at birth by an obstetrician/gynecologist, about 15 per cent by a family physician, 4.7 per cent by a nurse/nurse practitioner and 4.3 per cent by a midwife, according to the 2006 Canadian Maternity Experiences Survey from the Public Health Agency of Canada.