Abstract
BackgroundExperts in many countries are recommending a scaling up midwifery-led care as a model to improve maternal and newborn outcomes, reduce rates of unnecessary interventions, realise cost savings, and facilitate normal spontaneous vaginal birth.ObjectiveThe aim of this study was to compare midwifery-led and obstetrician-gynaecologist-led care-related vaginal birth outcomes.ParticipantsPregnant women in Kaunas city maternity care facilities.MethodsA propensity score-matched case–control study of midwifery-led versus physician-led low-risk birth outcomes. Patient characteristics and outcomes were compared between the groups. Continuous variables are presented as mean ± standard deviation and analysed using the Mann–Whitney U test. Categorical and binary variables are presented as frequency (percentage), and differences were analysed using the chi-square test. Analyses were conducted separately for the unmatched (before propensity score matched [PSM]) and matched (after PSM) groups.ResultsAfter adjusting groups for propensity score, postpartum haemorrhage differences between physician-led and midwifery-led labours were significantly different (169.5 and 152.6 mL; p = 0.026), same for hospital stay duration (3.3 and 3.1 days, p = 0.042). Also, in matched population, significant differences were seen for episiotomy rates (chi2 = 4.8; p = 0.029), newborn Apgar 5 min score (9.58 and 9.76; p = 0.002), and pain relief (chi2 = 14.9; p = 0.002). Significant differences were seen in unmatched but not confirmed in matched population for obstetrical procedures used during labour, breastfeeding, birth induction, newborn Apgar 1 min scores, and successful vaginal birth as an overall spontaneous vaginal birth success measure.ConclusionThe midwifery-led care model showed significant differences from the physician-led care model in episiotomy rates, hospital stay duration and postpartum haemorrhage, and newborn Apgar 5 min scores. Midwifery-led care is as safe as physician-led care and does not influence the rate of successful spontaneous vaginal births.
Highlights
In the most general sense, physician-led care can be associated with the biomedical model of care, which aims to reduce the risk of maternal/foetal/infant morbidity and mortality by screening, diagnosis, and treatment of potential complications as they develop [1]
Global health experts in many countries are recommending a scaling up midwifery-led care as a model to improve maternal and newborn outcomes, reduce rates of unnecessary interventions, realise cost savings, and facilitate normal spontaneous vaginal birth [4,5,6]
The study data were available for 1,848 singleton low-risk births from Kaunas city maternity care units with obstetric care
Summary
In the most general sense, physician-led care can be associated with the biomedical model of care, which aims to reduce the risk of maternal/foetal/infant morbidity and mortality by screening, diagnosis, and treatment of potential complications as they develop [1]. In contrast to the biomedical physician-led model, midwifery practice focuses on the normal biological processes of pregnancy, birth, and transition to parenthood [2]. Global health experts in many countries are recommending a scaling up midwifery-led care as a model to improve maternal and newborn outcomes, reduce rates of unnecessary interventions, realise cost savings, and facilitate normal spontaneous vaginal birth [4,5,6]. In settings with well-functioning midwifery programmes, WHO has recommended a midwifery-led continuity-of-care model, in which a known midwife or a small group of known midwives support a woman throughout the antenatal, intrapartum, and postnatal continuum [8,9]
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