Midwife-led continuity models versus other models of care: review and reflections

Chapman, S. Evidently Cochrane. Published online March 11 2016

midwife.jpgThe best way to organise maternity care, in terms of clinical and cost effectiveness, continues to be subject to debate.

Here in the UK, combinations of midwife-led, medical-led and shared models of care are available. Midwife-led continuity models of care vary but the defining feature is that a midwife, working with the woman, takes the lead in planning, organising and delivering her care from her first antenatal booking to the postnatal period. Sometimes a team of midwives shares a caseload. Midwife-led care in this review included care delivered in the hospital setting. A Cochrane review has found reliable evidence that there are benefits of midwife-led care compared with alternative approaches, for example where the lead professional is a doctor, or changes at different points.

The review

The Cochrane review includes 15 randomized controlled trials from the UK, Ireland, Canada and Australia, with 17,674 women with low- or mixed- risk pregnancies. All midwives involved were licensed. Home birth was not offered in any of the trials.

What they found

Women who had midwife-led care were less likely to experience regional analgesia, instrumental vaginal birth, preterm birth less than 37 weeks and fetal loss before 24 weeks gestation. They were more likely to have a longer labour, spontaneous vaginal birth and be attended at birth by a known midwife. There was no difference between the groups for a number of other outcomes including caesarean birth or intact perineum.Midwife-led care was associated with a number of important benefits for mothers and babies and had no more adverse effects than other models of care.

The review also provides some insight into women’s satisfaction with care and the costs of different models of care, although differences in the way these were measured meant that the results had to be described, rather than combined in a meta- analysis. Most studies reported greater satisfaction with various aspects of care in midwife-led continuity-led care compared with other models, and it appears to be cheaper than medical-led care.

Read the full summary here

Read the original research article here

Read the full Cochrane review here

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