Cochrane: Midwife-led care offers better outcomes for most pregnancies

A recent Cochrane review with 15 studies involving 17,674 women found that midwife-led care:

  • Had no adverse effects compared with doctor-led care;
  • Resulted in fewer epidurals, episiotomies or instrumental births;
  • Resulted in fewer preterm births, loss of baby before 24 weeks’ gestation, and overall loss of baby;
  • Resulted in increased patient (mother) satisfaction.

It concludes that most women should be offered midwife-led care

Australia has the highest number of midwives per 100,000 females worldwide yet over 30% of women give birth in private hospitals under obstetric care. Levels of instrumental and surgical intervention are on the increase, and Australia has a Caesarean rate of 32% (and is nearly 50% for women over the age of 40!), much higher than the ‘recommended’ rate of 10-15%. A dramatic increase from when Caeseareans were first measured in 1965 and the rate hovered around 4% – probably a combination of low actual rate and low reporting levels.

Why is this so? Insurance driven? Fear driven? Well-meaning doctors telling women that ‘the baby is too big to birth’ or ‘you are too old to push’? Or scheduling births around their own schedules?

International guidelines (such as the WHO) recommend that Caesarean sections be performed only when medically necessary. The evidence is strong but it seems no-one is listening.

REFERENCES
Sandall J, Soltani H, Gates S, et al. Midwife-led continuity models versus other models of care for childbearing women. Cochrane Database Syst Rev. 2015 Sep 15;9:CD004667.
Health at a Glance 2011 OECD Indicators.
Dahlen HG, Tracy S, Tracy M, et al. Rates of obstetric intervention among low-risk women giving birth in private and public hospitals in NSW: a population-based descriptive study. BMJ Open 2012;0: e001723

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