Tuesday, May 17, 2011

Midwife-led model of care about childbearing women. (Cochrane)

Midwife-led model of care about childbearing women is topic of research of many studies. I wrote about the socioeconomic aspect  in my previous post Socioeconomic value of Midwife (by RCM)
The Cochrane Library published Intervention Review about better delivery outcomes with fewer interventions.
Marie Hatem,, Jane Sandall, Declan Devane, Hora Soltani, Simon Gates:Midwife-led versus other models of care for childbearing women.
"The underpinning philosophy of midwife-led care is normality, continuity of care and being cared for by a known and trusted midwife during labour. There is an emphasis on the natural ability of women to experience birth with minimum intervention. 
The review of midwife-led care covered midwives providing care antenatally, during labour and postnatally. This was compared with models of medical-led care and shared care, and identified 11 trials, involving 12,276 women. Midwife-led care was associated with several benefits for mothers and babies, and had no identified adverse effects.
The main benefits were a reduction in the use of regional analgesia, with fewer episiotomies or instrumental births. Midwife-led care also increased the woman's chance of being cared for in labour by a midwife she had got to know, and the chance of feeling in control during labour, having a spontaneous vaginal birth and initiating breastfeeding. However, there was no difference in caesarean birth rates.

Women who were randomised to receive midwife-led care were less likely to lose their baby before 24 weeks' gestation, although there were no differences in the risk of losing the baby after 24 weeks, or overall. In addition, babies of women who were randomised to receive midwife-led care were more likely to have a shorter length of hospital stay.
The review concluded that most women should be offered midwife-led models of care, although caution should be exercised in applying this advice to women with substantial medical or obstetric complications."

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