Comparison of midwife-led and obstetrician-led care in Lithuania: A retrospective cohort study

Abstract

ObjectiveTo compare midwife-led and obstetrician-led care and their relation to caesarean section rates and obstetric and neonatal outcomes in low-risk births. DesignHospital registry based retrospective cohort study. SettingTertiary-care women's hospital in Kaunas, Lithuania. ParticipantsA total of 1384 and 1283 low-risk delivering women in 2012 and 2014, respectively. MethodsThe women choose either a midwife as their lead carer (midwife-led group), or an obstetrician-gynaecologist (obstetrician-led group). Main outcome measuresThe primary outcome was caesarean birth. Secondary outcomes included instrumental vaginal births, amniotomy, augmentation of labour, epidural analgesia, episiotomy, perineal trauma, labour duration, birthweight and Apgar score < 7 at 5 min. ResultsThe proportion of caesarean births was 4.4% in the midwife-led and 10.7% in the obstetrician-led group (p < 0.001) in 2012, and 5.2% and 11.8% (p < 0.001) in 2014, respectively.Younger maternal age (≤34 years) and midwife-led care was associated with a significantly decreased odds for caesarean section and nulliparity with a significantly increased odds for caesarean birth. Women in the midwife-led group had fewer amniotomies and labour augmentations compared with the obstetrician-led group. Episiotomy, perineal trauma, duration of labour and neonatal outcomes did not differ between the groups. ConclusionMidwife-led care for women with low-risk birth reduced the caesarean section and several medical interventions with no apparent increase in immediate adverse neonatal outcomes compared with obstetrician-led care. Implications for practiceMidwife-led care for low-risk women should be encouraged in countries with health care system where obstetrician-led care births dominates.