Pregnant women fare better under midwife-led care - study

Women at both low and high risk of complications examined in research involving NUI Galway

Dr Sam Coulter Smyth, master of the Rotunda Maternity Hospital in Dublin: would love to see women starting off with midwife-led care, once there was a seamless transfer to an obstetric-led unit if complications occurred. Photograph: Gareth Chaney Collins

Dr Sam Coulter Smyth, master of the Rotunda Maternity Hospital in Dublin: would love to see women starting off with midwife-led care, once there was a seamless transfer to an obstetric-led unit if complications occurred. Photograph: Gareth Chaney Collins

Wed, Aug 21, 2013, 08:01

Women who receive continuous care from midwives throughout pregnancy and birth fare better than women cared for by a combination of obstetricians, GPs and midwives, according to a new study to be published today.

Trials on more than 16,000 women, conducted by researchers at three British universities and NUI Galway (NUIG) found that those cared for by a small group of midwives throughout pregnancy were less likely to give birth pre-term and required fewer interventions during labour and birth than those whose care was shared.

Women at both low risk and at high risk of complications participated in the study, led by King’s College London, with NUIG, Sheffield Hallam University and the University of Warwick.


Happier patients
Women under midwife-led support were found to be happier with the care they received, had fewer epidurals, fewer assisted births and fewer episiotomies – or surgical incisions to reduce the risk of a tear.

This group were “no more likely” to have a Caesarean birth, but were in labour for about half an hour longer on average, according to the study published in The Cochrane Library.

NUIG notes that midwives act as main providers of care for women throughout pregnancy, labour and birth in many countries, including Britain and Australia, but 95 per cent of pregnant women in Ireland are booked directly into the care of a consultant obstetrician, even if the subsequent care is then midwife-managed.

The researchers reviewed data from 13 trials involving a total of 16,242 women.

The research teams found that women were less likely to give birth before 37 weeks or lose their babies before 24 weeks in a midwife-led setting.


Policy implications
Prof Declan Devane of NUIG’s school of nursing and midwifery said the work had “important policy implications”, in that it provided “high quality evidence of the benefits” of such care, supported by “appropriate multi-professional referral”.

“Other countries are using this to inform their maternity care policy and Ireland should do likewise,” he said.

Commenting on the findings, Dr Sam Coulter-Smith, master of the Rotunda Maternity Hospital in Dublin, said he would love to see women starting off with midwife-led care, once there was a seamless transfer to an obstetric-led unit if complications occurred.

The midwife-to-patient ratio in Dublin is “half what it should be”, he noted.