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If You Really Want A Natural Delivery... Call The Midwife
Date Posted: 21/Aug/2013
. Experts found women under the care of midwife needed fewer interventions
. They are less likely to lose their baby early or experience premature birth
. Mothers less likely to give birth prematurely or need epidural
Pregnant women whose care is led by a midwife are more likely to have natural births without complications, research shows. They are less likely to lose their baby early, experience premature birth, need an epidural or have their baby delivered with a surgical instrument. Experts found women under the care of a midwife needed fewer birth interventions than those under the care of consultants or GPs.
The team found that women cared for by midwives were 13 per cent less likely to need an epidural, 16 per cent less likely to need an episiotomy (surgical incision to reduce the risk of a tear) and 12 per cent less likely to need a forceps or ventouse (suction) delivery.
They were also more likely to give birth naturally, although they were in labour for an average of 30 minutes longer than other women. Women were also less likely to lose their baby before 24 weeks of gestation, although there was no difference over 24 weeks.
The research, published by the Cochrane Library, included experts from the School of Nursing and Midwifery at the National University of Ireland in Galway, Sheffield Hallam University and the University of Warwick. 
They analysed data involving 16,242 women from 13 studies carried out in Britain, Australia, Canada, Ireland and New Zealand. Their report said: ‘Midwife-led continuity of care was associated with several benefits for mothers and babies and had no identified adverse effects compared with models of medical-led care and shared care. 
‘The main benefits were a reduction in the use of epidurals, with fewer episiotomies or instrumental births. Women’s chances of being cared for in labour by a midwife she had got to know, and having a spontaneous vaginal birth were also increased. There was no difference in the number of Caesarean births.’
The team said women with high-risk pregnancies should still have the chance to consult specialist doctors and there should be clear guidance for midwives to refer women to other professionals. 
Professor Jane Sandall, of King’s College London, who was involved in the study, suggested reasons for the easier births among women cared for by midwives.
Two or three things could be going on here,’ she said. ‘Things may get picked up better when women know their midwives so they get better co-ordination of care. 
Shared care is more fragmented. Women may also find it easier to contact their midwives when they know them, which leads to better quality of care and missing fewer appointments. They also may feel safer, so there is a psychological benefit with less stress and anxiety. The Government has a mandate to get the same midwives looking after women throughout pregnancy.
In 2010, a survey found 43 per cent of women did not see the same midwife in pregnancy, and 75 per cent did not know the medical staff who delivered their baby.’
Professor Declan Devane, of the National University of Ireland, said: ‘This work has important policy implications and provides high quality evidence of the benefits for women and their infants of midwife-led models of care supported by appropriate multi-professional referral.’
The findings confirm previous research that midwife-led care results in fewer interventions for women during birth. In a statement, a spokesman for the Royal College of Midwives said: ‘This is a very important and welcome review. 
This research shows that having the same midwife provides significant benefits for women who have a medium or low risk during their pregnancy. Unfortunately, we know from surveys of maternity care, and anecdotally from women, that many women sadly do not experience such basic care. The writing is on the wall: this research shows that midwife-led care is what mothers and babies need and deserve.’

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