More than 90 percent of births in the U.S. are supervised by doctors, but a growing minority of women rely on midwives to provide their primary care. A new review, published by The Cochrane Library on Tuesday, lends support to that model, finding that consistent midwife care throughout pregnancy is linked with better outcomes for both mom and baby.
Compared with women who mainly saw family physicians or obstetricians, or whose care was shared by some mix of doctors, nurses and midwives, women who had a midwife as their lead provider had fewer interventions and were less likely to deliver a premature baby.
“Every woman should be aware of the benefits of midwifery-led care compared to obstetrician- or family physician-led care,” said Maureen Corry, executive director of Childbirth Connection, a national nonprofit focused on maternal care, who did not work on the paper. “This new Cochrane review is full of good news news for women and babies.”
The reviewers looked at 13 trials of more than 16,000 women who saw a small team of midwives throughout their pregnancy, or one primary midwife. Eight of the trials included women who were at low-risk for complications during pregnancy and birth, while five included higher-risk women. All of the midwives were licensed in their respective countries, and none of the trials looked at home births.
On the whole, women who saw midwives throughout their pregnancy were less likely to have an epidural painkiller, an episiotomy (an incision made from the vagina to anus during delivery), or a delivery using instruments, such as a vacuum or forceps. There were no differences in Cesarean birth rates.
Women who received continuous care from midwives also were less likely to have a baby before 37 weeks of gestation, or to lose their babies before 24 weeks.
Notably, higher-risk women who saw a midwife as their point-person did not have worse outcomes than low-risk women — a discovery the researchers interpreted with cautious optimism.