Comparison of delivery care provided by a midwife and by an obstetrician-gynaecologist in a low-risk pregnancy

Abstract

Aim: The aim of the study was to compare delivery care provided by a midwife (group of midwifes) and an obstetrician-gynaecologist (group of physicians) in a low-risk pregnancy. Objectives: To evaluate the number of obstetrical interventions and operative deliveries in women who belonged to the group of midwifes or physicians. To evaluate newborn-related data in both groups. Methods: A retrospective analysis was performed at the Department of Obstetrics and Gynaecology of the Lithuanian University of Health Sciences. All the deliveries in 2012 were classified using the 10-group Robson classification. Data on nulliparous (Group 1) and multiparous (Group 3) with a single cephalic term pregnancy with spontaneous labour and low-risk pregnancy were analysed further. Demographic and delivery-related information was collected and evaluated. Results: Data on 1446 deliveries were analysed. Midwives provided care for 30% (439) and obstetricians-gynaecologists for 70% (1007) of women. Physicians were more frequently responsible for elder women (29.4 ± 4.7 years vs 28.0 ± 5.29 years, p = 0.013) and primiparous (p = 0.006). Other demographic data did not differ between the two groups. Women from the group of physicians were more likely to undergo amniotomy (36.2% vs 27.6%, p = 0.001), oxytocin augmentation (32.6% vs 27.1%, p = 0.039) and epidural analgesia (32.6% vs 22.6%, p < 0.001). More caesarean sections were performed in this group as well (10.4% vs 4.3%, p < 0.001), both for primiparous (15.9% vs 8%, p = 0.005) and for multiparous (4.5% vs 0.9%, p = 0.012). Other results relating to delivery (number of cervical, vaginal and perineal tears, episiotomies, postpartum haemorrhage) and newborns outcomes (Apgar scores, weight) did not differ between the two groups. Conclusion: Women with low-risk pregnancies underwent fewer obstetrical interventions and caesarean sections when their delivery care was provided by a midwife.