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Midwife-led versus other models of care for childbearing women [entry]

Marie Hatem, Jane Sandall, Declan Devane, Hora Soltani, Simon Gates, Jane Sandall
2008 Cochrane Database of Systematic Reviews   unpublished
Midwife-led versus other models of care for childbearing women Midwife-led care confers benefits for pregnant women and their babies and is recommended. This is a Cochrane review abstract and plain language summary, prepared and Abstract Background Midwives are primary providers of care for childbearing women around the world. However, there is a lack of synthesised information to establish whether there are differences in morbidity and mortality, effectiveness and psychosocial outcomes between
more » ... al outcomes between midwife-led and other models of care. Objectives To compare midwife-led models of care with other models of care for childbearing women and their infants. All published and unpublished trials in which pregnant women are randomly allocated to midwife-led or other models of care during pregnancy, and where care is provided during the ante-and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. Data collection and analysis All authors evaluated methodological quality. Two authors independently checked the data extraction. Main results We included 11trials (12,276 women). Women who had midwife-led models of care were less likely to experience antenatal hospitalisation, risk ratio (RR) 0.90, 95% confidence interval (CI) 0.81 to 0.99), the use of regional analgesia (RR 0.81, 95% CI 0.73 to 0.91), episiotomy (RR 0.82, 95% CI 0.77 to 0.88), and instrumental delivery (RR 0.86, 95% CI 0.78 to 0.96) and were more likely to experience no intrapartum analgesia/anaesthesia (RR 1.16, 95% CI 1.05 to 1.29), spontaneous vaginal birth (RR 1.04, 95% CI 1.02 to 1.06), to feel in control during labour and childbirth (RR 1.74, 95% CI 1.32 to 2.30), attendance at birth by a known midwife (RR 7.84, 95% CI 4.15 to 14.81) and initiate breastfeeding (RR 1.35, 95% CI 1.03 to 1.76). In addition, women who were randomised to receive midwife-led care were less likely to experience fetal loss before 24 weeks' gestation (RR 0.79, 95% CI 0.65 to 0.97), and their babies were more likely to have a shorter length of hospital stay (mean difference -2.00, 95% CI -2.15 to -1.85). There were no statistically significant differences between groups for overall fetal loss/neonatal death (RR 0.83, 95% CI 0.70 to 1.00), or fetal loss/neonatal death of at least 24 weeks (RR 1.01, 95% CI 0.67 to 1.53).
doi:10.1002/14651858.cd004667.pub2 pmid:18843666 fatcat:lnogexhizrcfphdcwzglykcauy