August 28, 2014

What Effect Does the Continuity of Midwife-Led Care have on Pregnancy Outcomes?

With cesarean rates steadily climbing, some pregnant women hire midwives thinking that it may lower their risk of having to have the surgery. In 2008, a Cochrane review of midwife-led care (comprised primarily of midwives in teams) versus standard care, did not show a significant difference in cesarean rates.

However, investigators have recently conducted a randomized trial at a Melbourne, Australia hospital to determine whether a caseload model of midwifery care compared with standard care was associated with lower cesarean risk. This trial did show that pregnant women who received care (mostly) from one primary midwife, were less likely to have cesarean births and more likely to have a natural vaginal delivery.

In this trial they also found that those women receiving care in caseload midwifery were less likely to have episiotomies and epidurals than those in standard care. It was also revealed that infants born to those mothers in caseload midwifery were less likely to spend time in the NICU (neonatal intensive care unit).

McLachlan HL et al. Effects of continuity of care by a primary midwife (caseload midwifery) on caesarean section rates in women of low obstetric risk: The COSMOS randomized controlled trial. BJOG 2012 Nov; 119:1483. Diane J. Angelini, EdD, CNM, FACNM, FAAN, NEA-BC Published in Journal Watch Women’s Health November 8, 2012

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